Provider Demographics
NPI:1568438166
Name:DEITZ, DIANE MARIE (MSN, APNC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DEITZ
Suffix:
Gender:F
Credentials:MSN, APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 RTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4859
Mailing Address - Country:US
Mailing Address - Phone:732-776-4832
Mailing Address - Fax:732-776-4337
Practice Address - Street 1:1945 RTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4832
Practice Address - Fax:732-776-4337
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05307100363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090108TDAMedicare ID - Type Unspecified
NJQ41312Medicare UPIN