Provider Demographics
NPI:1699005967
Name:HARRIS, DIANNE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DIANNE
Other - Middle Name:MARIE
Other - Last Name:DOBROWOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4172 ANTLER LN
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-6817
Mailing Address - Country:US
Mailing Address - Phone:315-657-3752
Mailing Address - Fax:
Practice Address - Street 1:4172 ANTLER LN
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-6817
Practice Address - Country:US
Practice Address - Phone:315-657-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42024-1163W00000X, 163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health