Healthcare Provider Details

I. General information

NPI: 1659695229
Provider Name (Legal Business Name): DIEM N. DAO WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-98 MANHATTAN AVENUE
BROOKLYN NY
11206-2501
US

IV. Provider business mailing address

79 MADISON AVE FLOOR 6
NEW YORK NY
10016-7802
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-0390
  • Fax: 718-486-5741
Mailing address:
  • Phone: 212-554-2400
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305078
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: