Provider Demographics
NPI:1649290800
Name:ANDRESEN, DIANE MARIE (APN-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 WHITE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647
Mailing Address - Country:US
Mailing Address - Phone:201-837-0727
Mailing Address - Fax:201-837-8504
Practice Address - Street 1:517 WHITE AVE
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1018
Practice Address - Country:US
Practice Address - Phone:201-837-0727
Practice Address - Fax:201-837-8504
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00102200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health