Provider Demographics
NPI:1326557521
Name:LAM, DIANA SUK WAH (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:SUK WAH
Last Name:LAM
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 1:34 S BENNETT DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6323
Mailing Address - Country:US
Mailing Address - Phone:631-708-9750
Mailing Address - Fax:
Practice Address - Street 1:34 S BENNETT DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-6323
Practice Address - Country:US
Practice Address - Phone:631-708-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308381363LA2200X
RIAPRN01729363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health