Healthcare Provider Details

I. General information

NPI: 1548248545
Provider Name (Legal Business Name): DIANE MARIE EADE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE RADIATION ONCOLOGY-LIPSON CANCER CENTER
ROCHESTER NY
14621-3001
US

IV. Provider business mailing address

27 BELMANOR DR
ROCHESTER NY
14623-3001
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4031
  • Fax: 585-922-2971
Mailing address:
  • Phone: 585-427-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332471-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: