Provider Demographics
NPI:1982676557
Name:NORRIS, DIANA JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JEAN
Last Name:NORRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:JEAN
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:27 NAEK RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3942
Mailing Address - Country:US
Mailing Address - Phone:860-875-2444
Mailing Address - Fax:860-872-2936
Practice Address - Street 1:27 NAEK RD
Practice Address - Street 2:UNIT 2
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3942
Practice Address - Country:US
Practice Address - Phone:860-875-2444
Practice Address - Fax:860-872-2936
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001613363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004212768Medicaid
CT500000500Medicare PIN
S52023Medicare UPIN