Healthcare Provider Details

I. General information

NPI: 1568438166
Provider Name (Legal Business Name): DIANE MARIE DEITZ MSN, APNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 RTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

1945 RTE 33
NEPTUNE NJ
07753-4859
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4832
  • Fax: 732-776-4337
Mailing address:
  • Phone: 732-776-4832
  • Fax: 732-776-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NN05307100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: