Healthcare Provider Details

I. General information

NPI: 1306371471
Provider Name (Legal Business Name): DIANA ELLEN MCDONNELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVENUE HIP-8
NEW YORK NY
10032
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE FL 9
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 646-317-6041
  • Fax: 212-305-6891
Mailing address:
  • Phone: 646-317-6041
  • Fax: 212-305-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number717786-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308556-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: