Healthcare Provider Details

I. General information

NPI: 1700109642
Provider Name (Legal Business Name): DIANA PATRICIA POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA PATRICIA REID-ROBERTS RN

II. Dates (important events)

Enumeration Date: 03/06/2010
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 ELM ST
VALLEY STREAM NY
11580-4913
US

IV. Provider business mailing address

147 ELM ST
VALLEY STREAM NY
11580-4913
US

V. Phone/Fax

Practice location:
  • Phone: 516-559-0549
  • Fax:
Mailing address:
  • Phone: 516-559-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP1219157
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP034155
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10034873
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0138347
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338120
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15403
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number618692
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1104323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: