Healthcare Provider Details

I. General information

NPI: 1689845703
Provider Name (Legal Business Name): DIANE GUARASCIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST
HACKENSACK NJ
07601-7113
US

IV. Provider business mailing address

90 MAIN ST
HACKENSACK NJ
07601-7113
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-5241
  • Fax:
Mailing address:
  • Phone: 845-359-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number475786
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: