Provider Demographics
NPI:1235674706
Name:CUERVO, DIANE M (LPN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:CUERVO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4003
Mailing Address - Country:US
Mailing Address - Phone:718-496-8678
Mailing Address - Fax:
Practice Address - Street 1:9 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4003
Practice Address - Country:US
Practice Address - Phone:718-496-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314891-1164W00000X
NJ26NP06981300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse