Healthcare Provider Details

I. General information

NPI: 1265819080
Provider Name (Legal Business Name): DIANA PINCHUK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W FIFTH AVENUE
FLINT MI
48503
US

IV. Provider business mailing address

1114 CLANCY AVE
FLINT MI
48503-3341
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3705
  • Fax:
Mailing address:
  • Phone: 810-835-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704262823
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: