Provider Demographics
NPI:1386866879
Name:MAZEROLLE, DIANE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:MAZEROLLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:KENDUSKEAG
Mailing Address - State:ME
Mailing Address - Zip Code:04450
Mailing Address - Country:US
Mailing Address - Phone:207-884-6068
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND PL STE 108
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5087
Practice Address - Country:US
Practice Address - Phone:207-990-9000
Practice Address - Fax:207-945-8645
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse