Provider Demographics
NPI:1144584145
Name:MCGILL, DIANE (BSN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1419
Mailing Address - Country:US
Mailing Address - Phone:207-310-0824
Mailing Address - Fax:
Practice Address - Street 1:820 PEARL ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4411
Practice Address - Country:US
Practice Address - Phone:508-583-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN118624374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN118624OtherRN