Provider Demographics
NPI:1225028194
Name:KNIGHT, DIANE (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-749-4963
Mailing Address - Fax:
Practice Address - Street 1:15 OLD ROLLINSFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2869
Practice Address - Country:US
Practice Address - Phone:603-749-4963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033309-23363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078211Medicaid
ME1225028194Medicaid
NHT400149922Medicare PIN
NHNP023301Medicare PIN
NHS32352Medicare UPIN