Provider Demographics
NPI:1417159351
Name:DIAZ, MARCY M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:M
Last Name:DIAZ
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:URB ISLAUZL 3005
Mailing Address - Street 2:CALLE JAMAICA
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-830-2707
Mailing Address - Fax:787-830-0465
Practice Address - Street 1:URB ISLAUZL 3005
Practice Address - Street 2:CALLE JAMAICA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-2707
Practice Address - Fax:787-830-0465
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28098163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse