Provider Demographics
NPI:1306371471
Name:MCDONNELL, DIANA ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELLEN
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:646-317-6041
Mailing Address - Fax:212-305-6891
Practice Address - Street 1:161 FORT WASHINGTON AVENUE
Practice Address - Street 2:HIP-8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:646-317-6041
Practice Address - Fax:212-305-6891
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717786-1163WM0705X
NYF308556-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical