Provider Demographics
NPI:1356354872
Name:SMITH, DIANNE LUCILLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:LUCILLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:41 VALLEY GREEN DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1721
Mailing Address - Country:US
Mailing Address - Phone:585-388-6657
Mailing Address - Fax:585-388-6657
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-6011
Practice Address - Fax:585-275-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY333024363LF0000X
NYF-333024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily