Healthcare Provider Details

I. General information

NPI: 1164467478
Provider Name (Legal Business Name): DIANE VOLZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE SUITE 310
HAMDEN CT
06518-3691
US

IV. Provider business mailing address

2408 WHITNEY AVE PO BOX 5576
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-407-1500
  • Fax: 203-230-4794
Mailing address:
  • Phone: 203-407-1500
  • Fax: 203-230-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE36027
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000262
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: