Provider Demographics
NPI:1134284805
Name:HALL, DIANE P (RN, PCNS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ROCKY BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8121
Mailing Address - Country:US
Mailing Address - Phone:401-788-0311
Mailing Address - Fax:
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:H-3
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-789-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00005163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult