Provider Demographics
NPI:1295442507
Name:KORNEEVA, DIANA (MS, FNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KORNEEVA
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BRIGHTON 2ND PL APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7067
Mailing Address - Country:US
Mailing Address - Phone:347-449-3691
Mailing Address - Fax:
Practice Address - Street 1:3065 BRIGHTON 7TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5997
Practice Address - Country:US
Practice Address - Phone:718-576-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily