Individual
MRS. DIANE M MOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
795 WISCONSIN AVE, BAY SHORE, NY 11706-2336
(631) 434-2401
Mailing address
839 LAFAYETTE AVE, BOHEMIA, NY 11716-4407
(631) 218-4711
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
5185771
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5185771
RN LICENSE NUMBER
NY
Enumeration date
07/22/2018
Last updated
07/22/2018
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