Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NN07015600 | NJ |
NPI | 1013939933 |
---|---|
Provider Name | Diane Yacono |
First Address | Manalapan, NJ 07726-4617 |
Second Address | Freehold, NJ 07728-2537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |