Provider Demographics
NPI:1891375119
Name:LEAMAN, DIANA MARIE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:LEAMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:NADEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 REVERE CT
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4047
Mailing Address - Country:US
Mailing Address - Phone:401-318-5808
Mailing Address - Fax:
Practice Address - Street 1:506 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1802
Practice Address - Country:US
Practice Address - Phone:508-984-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist