Provider Demographics
NPI:1992715262
Name:PREVO, DIANNE PATRICIA (APRN BC)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:PATRICIA
Last Name:PREVO
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:PATRICIA
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HIGHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477
Mailing Address - Country:US
Mailing Address - Phone:802-434-6672
Mailing Address - Fax:
Practice Address - Street 1:586 OAKHILL ROAD
Practice Address - Street 2:THOMAS CHITTENDEN HEALTH CENTER
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:802-879-6853
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010011670363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health