Provider Demographics
NPI:1144523598
Name:HAUCK-JOHNSON, DIANNE ROSE (RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:ROSE
Last Name:HAUCK-JOHNSON
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5904
Mailing Address - Country:US
Mailing Address - Phone:347-482-7042
Mailing Address - Fax:
Practice Address - Street 1:1516 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5904
Practice Address - Country:US
Practice Address - Phone:347-482-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332452-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily