Individual
MRS. THERESA ANN DIRESTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
700 OSBORN AVE, RIVERHEAD, NY 11901-2912
(631) 369-6799
(631) 369-6822
Mailing address
PO BOX 28, JAMESPORT, NY 11947-0028
(631) 722-5339
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
376091-1
NY
Other
Enumeration date
04/08/2013
Last updated
04/17/2013
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