# DIANA D MATLACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1922097187
- **Gender:** F
- **Credential:** CNM

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | 245276 | TX | — |
| 367A00000X | Advanced Practice Midwife | F000623 | NY | Yes |

## Other

- **Enumeration date:** 10/19/2005
- **Last updated:** 03/14/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01793140 | — | NY |
| 01 | — | 10039144 | CDPHP | — |
| 01 | — | 918024 | MVP | — |