Provider Demographics
NPI:1821333840
Name:RADZIEWICZ, DIANE JUDITH (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JUDITH
Last Name:RADZIEWICZ
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 1:1 CLOCKTOWER PL
Mailing Address - Street 2:APT 527
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3374
Mailing Address - Country:US
Mailing Address - Phone:603-595-4243
Mailing Address - Fax:603-880-3171
Practice Address - Street 1:45 HIGH ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3312
Practice Address - Country:US
Practice Address - Phone:603-595-4243
Practice Address - Fax:603-880-3171
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017839-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse