Healthcare Provider Details

I. General information

NPI: 1639558570
Provider Name (Legal Business Name): DIANN CLANSY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HAMILTON AVE
MONTICELLO NY
12701-1319
US

IV. Provider business mailing address

PO BOX 337
SOUTH FALLSBURG NY
12779-0337
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax: 845-791-1716
Mailing address:
  • Phone: 845-423-8178
  • Fax: 845-791-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number623958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: