Provider Demographics
NPI:1558648303
Name:PELLIGRA, DIANE F (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:F
Last Name:PELLIGRA
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 1:715 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1538
Mailing Address - Country:US
Mailing Address - Phone:315-435-5851
Mailing Address - Fax:315-435-5869
Practice Address - Street 1:715 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-1538
Practice Address - Country:US
Practice Address - Phone:315-435-5851
Practice Address - Fax:315-435-5869
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420246-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse