Provider Demographics
NPI:1932266343
Name:EPSTEIN, DIANE ANDREN (MSN,FNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ANDREN
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:MSN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PAWTUCKET ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3501
Mailing Address - Country:US
Mailing Address - Phone:978-453-5294
Mailing Address - Fax:978-453-5197
Practice Address - Street 1:241 PAWTUCKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3501
Practice Address - Country:US
Practice Address - Phone:978-453-5294
Practice Address - Fax:978-453-5197
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MER031505OtherMAINE NP LICENSE #
MANP0286OtherBCBS PROVIDER #
MA155819OtherMA LICENSE #
MANP0286OtherBCBS PROVIDER #