Healthcare Provider Details

I. General information

NPI: 1194893230
Provider Name (Legal Business Name): DIANE KUPENSKY RN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-2199
  • Fax: 330-480-2750
Mailing address:
  • Phone: 330-480-2199
  • Fax: 330-480-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN144457
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCOA06136NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: