Provider Demographics
NPI:1770882912
Name:MORGAN, DIANE (NP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E BROADWAY
Mailing Address - Street 2:APT. 203
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4323
Mailing Address - Country:US
Mailing Address - Phone:516-574-9594
Mailing Address - Fax:
Practice Address - Street 1:330 E BROADWAY
Practice Address - Street 2:APT. 203
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4323
Practice Address - Country:US
Practice Address - Phone:516-574-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305318-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health