Provider Demographics
NPI:1417965401
Name:MONAHAN, DIANE MARY (LPN BSN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARY
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:LPN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:3641 ST RT 55
Mailing Address - City:KAUNEONGA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12749
Mailing Address - Country:US
Mailing Address - Phone:845-583-6195
Mailing Address - Fax:
Practice Address - Street 1:39 OLD MONTICELLO RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734
Practice Address - Country:US
Practice Address - Phone:845-292-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14890164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse