Provider Demographics
NPI:1053329482
Name:PRICE, DIANE M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPENCER ST
Mailing Address - Street 2:APT 205
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-6317
Mailing Address - Country:US
Mailing Address - Phone:315-527-6178
Mailing Address - Fax:603-727-9226
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:4
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302200-1363LG0600X
NH071559-23363LA2200X
VT101.0113503363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP29484Medicare UPIN
NYP29484Medicare UPIN