Provider Demographics
NPI:1790111565
Name:VELEZ, DIANA (LPN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VELEZ
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 1:1206 VISTA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-3014
Mailing Address - Country:US
Mailing Address - Phone:347-776-1631
Mailing Address - Fax:
Practice Address - Street 1:1206 VISTA VIEW DR
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-3014
Practice Address - Country:US
Practice Address - Phone:347-776-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3079521164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse