Provider Demographics
NPI:1992270193
Name:ANDERSON, DIANE M (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CUSHMAN RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0746
Mailing Address - Country:US
Mailing Address - Phone:207-314-3141
Mailing Address - Fax:207-453-6250
Practice Address - Street 1:1604 BENTON AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-3327
Practice Address - Country:US
Practice Address - Phone:207-453-4708
Practice Address - Fax:207-453-6250
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN21421163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health