Healthcare Provider Details

I. General information

NPI: 1194393728
Provider Name (Legal Business Name): N'KEYAH DIAZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PENNACOOK ST
MANCHESTER NH
03104-3554
US

IV. Provider business mailing address

131 WATER ST
FITCHBURG MA
01420
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-7321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number112093-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10004904
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2351078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: