Provider Demographics
NPI:1457991333
Name:MLADJEN, DIANE (APRN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MLADJEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MLADJEN
Other - Last Name:IANNINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:56 JOSHUA HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3517
Mailing Address - Country:US
Mailing Address - Phone:203-240-4438
Mailing Address - Fax:
Practice Address - Street 1:56 JOSHUA HILL RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3517
Practice Address - Country:US
Practice Address - Phone:203-240-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily