1154415966 NPI number — MS. DIANE JEANETTE TRUE LICENSED INDEPENDENT

Table of content: MS. DIANE JEANETTE TRUE LICENSED INDEPENDENT (NPI 1154415966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154415966 NPI number — MS. DIANE JEANETTE TRUE LICENSED INDEPENDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUE
Provider First Name:
DIANE
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED INDEPENDENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALOOF
Provider Other First Name:
DIANE
Provider Other Middle Name:
JEANETTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154415966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1902
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
SUITE 2F
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-475-7669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  102148 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012510 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 721589 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P02934 . This is a "BCBS OF MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051649000 . This is a "MAGELLAN PIN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013270 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 100515 . This is a "MAGELLAN PIN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com