Provider Demographics
NPI:1679549448
Name:MERICNYAK, DIANE MARLA (CRNA)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARLA
Last Name:MERICNYAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JANS CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2658
Mailing Address - Country:US
Mailing Address - Phone:203-452-7276
Mailing Address - Fax:203-452-7276
Practice Address - Street 1:6 JANS CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2658
Practice Address - Country:US
Practice Address - Phone:203-452-7276
Practice Address - Fax:203-452-7276
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000217367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered