Provider Demographics
NPI:1932547981
Name:FORD, DIANE MARIE (RN-BSN)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 KINGSLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612
Mailing Address - Country:US
Mailing Address - Phone:585-581-0426
Mailing Address - Fax:
Practice Address - Street 1:79 KINGSLEY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-5419
Practice Address - Country:US
Practice Address - Phone:585-581-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357160-1163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology