Provider Demographics
NPI:1881680650
Name:MCMAINS, DIANA JOYCE (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JOYCE
Last Name:MCMAINS
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:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-0486
Mailing Address - Country:US
Mailing Address - Phone:727-641-4818
Mailing Address - Fax:
Practice Address - Street 1:3050 REGENT BLVD. SUITE 200
Practice Address - Street 2:EXAMINATION MANAGEMENT SERVICES
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:214-689-8178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR30131363LW0102X
NMCNP00601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health