Healthcare Provider Details

I. General information

NPI: 1528295979
Provider Name (Legal Business Name): DIANNE WOLFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 VIOLET AVE
POUGHKEEPSIE NY
12601-1034
US

IV. Provider business mailing address

370 VIOLET AVE
POUGHKEEPSIE NY
12601-1034
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-1807
  • Fax: 845-471-1815
Mailing address:
  • Phone: 845-471-1807
  • Fax: 845-471-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number505770
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: