Provider Demographics
NPI:1467573279
Name:MEDEIROS, DIANA (CRNA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BENT RD
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2205
Mailing Address - Country:US
Mailing Address - Phone:401-456-2666
Mailing Address - Fax:
Practice Address - Street 1:60 BENT RD
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-2205
Practice Address - Country:US
Practice Address - Phone:401-490-7551
Practice Address - Fax:401-490-7534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA29470367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007050123Medicare ID - Type UnspecifiedMEDICARE NUMBER