Provider Demographics
NPI:1275418113
Name:NGUYEN, DIANA V (PA-C)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 W STATE ST.
Mailing Address - Street 2:PO BOX 116
Mailing Address - City:ST. BONAVENTURE
Mailing Address - State:NY
Mailing Address - Zip Code:14778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3261 W STATE ST.
Practice Address - Street 2:PO BOX 116
Practice Address - City:ST. BONAVENTURE
Practice Address - State:NY
Practice Address - Zip Code:14778
Practice Address - Country:US
Practice Address - Phone:716-375-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant