Provider Demographics
NPI:1376563197
Name:PORTER, DIANA C (FNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:33 WHITING HILL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1021
Practice Address - Country:US
Practice Address - Phone:207-973-7478
Practice Address - Fax:207-973-7807
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-08-16
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Provider Licenses
StateLicense IDTaxonomies
MER028880207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S70148Medicare UPIN
S70148Medicare UPIN