Provider Demographics
NPI:1144926767
Name:ELMAN, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE STE 6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2624
Mailing Address - Country:US
Mailing Address - Phone:575-425-6047
Mailing Address - Fax:575-446-0050
Practice Address - Street 1:717 ENCINO PL NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2624
Practice Address - Country:US
Practice Address - Phone:575-425-6047
Practice Address - Fax:575-446-0050
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1083931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health