Provider Demographics
NPI:1053157800
Name:NORSTROM, DIANNE YVONNE (LPN)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:YVONNE
Last Name:NORSTROM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25103 COUNTY ROUTE 16
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-4148
Mailing Address - Country:US
Mailing Address - Phone:315-937-6482
Mailing Address - Fax:
Practice Address - Street 1:25103 COUNTY ROUTE 16
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-4148
Practice Address - Country:US
Practice Address - Phone:315-937-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293536-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse