Healthcare Provider Details

I. General information

NPI: 1114427283
Provider Name (Legal Business Name): DIANE E MARCHITTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FOREST AVE
BUFFALO NY
14213-1207
US

IV. Provider business mailing address

400 FOREST AVE
BUFFALO NY
14213-1207
US

V. Phone/Fax

Practice location:
  • Phone: 716-816-2413
  • Fax:
Mailing address:
  • Phone: 716-816-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number421207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: