Provider Demographics
NPI:1205399417
Name:BLASCZIENSKI, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BLASCZIENSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4820
Mailing Address - Country:US
Mailing Address - Phone:315-529-3498
Mailing Address - Fax:
Practice Address - Street 1:11 MARYLAND DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4820
Practice Address - Country:US
Practice Address - Phone:315-529-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451634-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse