Provider Demographics
NPI:1013994706
Name:SANCHEZ, DIANE (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN
Mailing Address - Street 2:PRIME HEALTHCARE
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:893 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2292
Practice Address - Country:US
Practice Address - Phone:860-528-4124
Practice Address - Fax:860-282-1213
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001768363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400001768CT01OtherBC/BS
CT0001768OtherMEDICAL LICENSE
CT004203171Medicaid
CT004203171Medicaid
CT400001768CT01OtherBC/BS
CTMS0317253OtherDEA