Healthcare Provider Details

I. General information

NPI: 1316957285
Provider Name (Legal Business Name): DIANE GUARDIANI PMHNP (APRN)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 FLANDERS RD STE B1
NIANTIC CT
06357-1211
US

IV. Provider business mailing address

170 FLANDERS RD STE B1
NIANTIC CT
06357-1211
US

V. Phone/Fax

Practice location:
  • Phone: 860-385-6547
  • Fax: 860-807-1613
Mailing address:
  • Phone: 860-385-6547
  • Fax: 860-807-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002409
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2409
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: