Individual
DIANE ELIZABETH WAHNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
122 W ROE BLVD, PATCHOGUE, NY 11772-2569
(631) 493-7636
Mailing address
15 NEW MILL RD, SMITHTOWN, NY 11787-3323
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402469
NY
Other
Enumeration date
07/26/2018
Last updated
05/11/2019
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