Provider Demographics
NPI:1982975124
Name:ROSERIE, DIANA OSBORNE
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:OSBORNE
Last Name:ROSERIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 EAST 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1259
Mailing Address - Country:US
Mailing Address - Phone:718-998-0200
Mailing Address - Fax:718-339-4172
Practice Address - Street 1:1663 EAST 17TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1259
Practice Address - Country:US
Practice Address - Phone:718-998-0200
Practice Address - Fax:718-339-4172
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396627-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse