Provider Demographics
NPI:1740404268
Name:WAIFIELD, DIANE M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:WAIFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:1024 WEST MAIN ST
Mailing Address - City:BURKE
Mailing Address - State:NY
Mailing Address - Zip Code:12917
Mailing Address - Country:US
Mailing Address - Phone:518-483-7022
Mailing Address - Fax:
Practice Address - Street 1:1024 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:NY
Practice Address - Zip Code:12917
Practice Address - Country:US
Practice Address - Phone:518-483-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02421570OtherPROVIDER ID NUMBER