Provider Demographics
NPI:1538138771
Name:BERNER, DIANE C (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:BERNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4758
Mailing Address - Country:US
Mailing Address - Phone:617-654-7111
Mailing Address - Fax:781-221-2637
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:617-654-7111
Practice Address - Fax:781-221-2637
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128309363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF967OtherHARVARD PILGRIM
MANP2100OtherBLUE CROSS
MA0370100Medicaid
MA0370100Medicaid
MAS93949Medicare UPIN