Provider Demographics
NPI:1659408235
Name:CLINTON, DIANE F (APRN, BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:CLINTON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-5130
Mailing Address - Country:US
Mailing Address - Phone:978-671-9160
Mailing Address - Fax:
Practice Address - Street 1:130 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-5130
Practice Address - Country:US
Practice Address - Phone:978-671-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN137269364SP0808X
MA137269163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7670192OtherAETNA PROVIDER NETWORK
MAPN0164OtherBLUE CROSS BLUE SHEILD
MA148070000OtherMAGELLAN
MA286539OtherPACIFICARE BEHAVIORAL HEA
MA003849OtherHARVARD PILGRIM HEALTH CA
MA711959OtherTUFTS HEALTH PLAN
MAS71392Medicaid