Provider Demographics
NPI:1104097153
Name:FORNASIER, DIANNA (RN CDCES)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:FORNASIER
Suffix:
Gender:F
Credentials:RN CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1333
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-1333
Mailing Address - Country:US
Mailing Address - Phone:907-843-2206
Mailing Address - Fax:
Practice Address - Street 1:BRISTOL BAY AREA HEALTH CORPORATION
Practice Address - Street 2:6000 KANKANAK RD
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-843-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AKNURR33215163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG921Medicaid