Individual
DIANA D MATLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
2495 SAWDUST RD APT 1101, SPRING, TX 77380-3365
(315) 216-6625
Mailing address
2495 SAWDUST RD APT 1101, SPRING, TX 77380-3365
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
245276
TX
367A00000X
Advanced Practice Midwife
Primary
F000623
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01793140
—
NY
01
—
10039144
CDPHP
—
01
—
918024
MVP
—
Enumeration date
10/19/2005
Last updated
03/14/2013
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