Provider Demographics
NPI:1790081867
Name:DEMERS DUBE, DIANE MARIE (CRNA, APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DEMERS DUBE
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:173 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3508
Mailing Address - Country:US
Mailing Address - Phone:603-788-4911
Mailing Address - Fax:
Practice Address - Street 1:173 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3508
Practice Address - Country:US
Practice Address - Phone:603-788-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH042592-23363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7915Medicare PIN
NHNH0022Medicare PIN