Provider Demographics
NPI:1891412821
Name:EANNOTTI, DIANE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:EANNOTTI
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CROSSBOW LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1753
Mailing Address - Country:US
Mailing Address - Phone:203-260-3650
Mailing Address - Fax:
Practice Address - Street 1:10 CROSSBOW LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1753
Practice Address - Country:US
Practice Address - Phone:203-260-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily