Individual
DIAVONNI KIMBERLEY BLYTHE EDINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
380 WASHINGTON AVE, ROOSEVELT, NY 11575-1845
(516) 378-2000
Mailing address
380 WASHINGTON AVE, ROOSEVELT, NY 11575-1845
(516) 378-2000
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
762316
NY
Other
Enumeration date
03/09/2021
Last updated
03/09/2021
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