| NPI | 1275961609 |
|---|---|
| Former Name | DIANA MARIE DICICCO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000215) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171070) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2014-07-18 |