Provider Demographics
NPI:1629367412
Name:DIAZ, MEGAN NICHOLE (RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICHOLE
Last Name:DIAZ
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 1:175 ALTAIR DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1429
Mailing Address - Country:US
Mailing Address - Phone:716-908-5785
Mailing Address - Fax:
Practice Address - Street 1:175 ALTAIR DR
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1429
Practice Address - Country:US
Practice Address - Phone:716-908-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630786-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45-1328304OtherIRS EMPLOYEE IDENTIFICATION NUMBER