Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 269150-1 | NY |
NPI | 1003109620 |
---|---|
Provider Name | Dr. Diana Rachael Nordquist |
First Address | North Bellmore, NY 11710-2045 |
Second Address | West Haven, CT 06516-2770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 09/09/2016 |