Provider Demographics
NPI:1780260943
Name:DIAHN, BAE GOLDA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:BAE
Middle Name:GOLDA
Last Name:DIAHN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WINEGAR LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1449
Mailing Address - Country:US
Mailing Address - Phone:347-612-1255
Mailing Address - Fax:
Practice Address - Street 1:19 WINEGAR LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1449
Practice Address - Country:US
Practice Address - Phone:347-612-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY788834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse