Doctor Name: | MS. DIANE MANUS-BIANCULLI |
NPI Number: | 1740403641 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP,C |
License Number: | F302342 |
Business Practice Address: | 1600 Brecknock Rd Greenport, NY - 119443100 |
Business Phone Number: | 6314774216 |
Business Fax Number: | 6314774065 |
Mailing Address: | 1600 Brecknock Rd, GREENPORT |
State: | NY |
Postal Code: | 119443100 |
Phone Number: | 6314774216 |
Fax Number: | 6314774065 |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | F302342 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |