1659461796 NPI number — DIANNE M SCHERMERHORN RNP BC

Table of content: DIANNE M SCHERMERHORN RNP BC (NPI 1659461796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659461796 NPI number — DIANNE M SCHERMERHORN RNP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHERMERHORN
Provider First Name:
DIANNE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNP BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAIR
Provider Other First Name:
DIANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNP BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659461796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLFLEET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-240-0208
Provider Business Mailing Address Fax Number:
508-240-0499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3130 STATE HIGHWAY ROUTE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLFLEET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-349-3131
Provider Business Practice Location Address Fax Number:
508-349-1311
Provider Enumeration Date:
10/12/2006

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: 363LA2200X , with the licence number:  107100 , 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)