Provider Demographics
NPI:1194382648
Name:MISLANG, DIANA JOSEPHINE ESTRADA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANA JOSEPHINE
Middle Name:ESTRADA
Last Name:MISLANG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8022
Mailing Address - Country:US
Mailing Address - Phone:212-523-5559
Mailing Address - Fax:212-523-2004
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-8022
Practice Address - Country:US
Practice Address - Phone:212-523-5559
Practice Address - Fax:212-523-2004
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily