Healthcare Provider Details

I. General information

NPI: 1831032143
Provider Name (Legal Business Name): DIASIA LIARRA POLK PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W RADISON RUN
CLAYTON DE
19938-3826
US

IV. Provider business mailing address

308 W RADISON RUN
CLAYTON DE
19938-3826
US

V. Phone/Fax

Practice location:
  • Phone: 302-359-8223
  • Fax:
Mailing address:
  • Phone: 302-359-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0011100
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: