Provider Demographics
NPI:1841355567
Name:FLETCHER, DIANE MARIE (RN, NP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:610 WAMPANOAG TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1504
Mailing Address - Country:US
Mailing Address - Phone:401-431-9870
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1504
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP26513363LA2200X
RIRN26513163WC0400X
RI00195364SP0809X
RI26513364SP0809X
RI01195364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMB1329918OtherDEA REGISTRATION