Individual
DIANE POULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
33 LEAHY AVE, BRENTWOOD, NY 11717-1011
(631) 434-5845
Mailing address
2 6TH AVE, BRENTWOOD, NY 11717-6110
(631) 434-2401
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
507627
NY
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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