Provider Demographics
NPI:1639485089
Name:DIAMOND, RACHEL TAMAR (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:TAMAR
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ROCHEL
Other - Middle Name:
Other - Last Name:KIRSHENBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1407
Mailing Address - Country:US
Mailing Address - Phone:917-756-4807
Mailing Address - Fax:
Practice Address - Street 1:932 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4506
Practice Address - Country:US
Practice Address - Phone:646-680-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197215363LF0000X
NYF3444991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily