Provider Demographics
NPI:1013551357
Name:MABERRY, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MABERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04938-3123
Mailing Address - Country:US
Mailing Address - Phone:207-779-4242
Mailing Address - Fax:
Practice Address - Street 1:122 VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHESTERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04938-3123
Practice Address - Country:US
Practice Address - Phone:207-779-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider