Provider Demographics
NPI:1831674647
Name:DIAMOND, REBECCA C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:C
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:24 BRIDGE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4922
Mailing Address - Country:US
Mailing Address - Phone:603-415-0090
Mailing Address - Fax:833-944-2250
Practice Address - Street 1:24 BRIDGE ST STE 9
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4922
Practice Address - Country:US
Practice Address - Phone:603-415-0090
Practice Address - Fax:833-944-2250
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH059653-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3116119Medicaid