Provider Demographics
NPI:1790075869
Name:CLAYTON, DIANA CAROLINE JENNINGS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:CAROLINE JENNINGS
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CAROLINE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:130 FISHER RD
Mailing Address - Street 2:# 3-1
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9516
Mailing Address - Country:US
Mailing Address - Phone:802-225-7000
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:# 3-1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010076190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily