Provider Demographics
NPI:1578522348
Name:HARRISON, DIANNE EMILY (RN, MSCN, AOCN, APNC)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:EMILY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RN, MSCN, AOCN, APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SHELTON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2814
Mailing Address - Country:US
Mailing Address - Phone:201-888-2104
Mailing Address - Fax:
Practice Address - Street 1:275-277 FOREST AVE STE 125
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5423
Practice Address - Country:US
Practice Address - Phone:551-278-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC09738500163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1166050Medicaid
NJ043678Medicare ID - Type Unspecified
NJP18681Medicare UPIN