Provider Demographics
NPI:1386192755
Name:KRESL, DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:KRESL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 MARABOOTS CIR
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-2080
Mailing Address - Country:US
Mailing Address - Phone:505-334-9414
Mailing Address - Fax:505-599-4387
Practice Address - Street 1:500 E CHACO ST
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2170
Practice Address - Country:US
Practice Address - Phone:505-334-9414
Practice Address - Fax:505-599-4387
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR30362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse