Provider Demographics
NPI:1194135111
Name:DIMOU, CIARA IRENE (RN, NP)
Entity type:Individual
Prefix:MISS
First Name:CIARA
Middle Name:IRENE
Last Name:DIMOU
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:421 MERRIMACK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5864
Mailing Address - Country:US
Mailing Address - Phone:978-725-4822
Mailing Address - Fax:
Practice Address - Street 1:41 MALL ROAD
Practice Address - Street 2:LAHEY HOSPITAL AND MEDICAL CENTER
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-7000
Practice Address - Fax:781-744-5351
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2284486363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100418AMedicaid
MAS400204603Medicare PIN