Provider Demographics
NPI:1952448813
Name:PASCUCCI, DIANE ASSUNTA (RN,MS,CS,MED)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ASSUNTA
Last Name:PASCUCCI
Suffix:
Gender:F
Credentials:RN,MS,CS,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ELMBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1846
Mailing Address - Country:US
Mailing Address - Phone:781-275-2830
Mailing Address - Fax:
Practice Address - Street 1:27 ELMBROOK RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1846
Practice Address - Country:US
Practice Address - Phone:781-275-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115136364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA004017701OtherAMERICAN NURSES CRED CTR
MA115136OtherRN LICENSE
MAPN0206OtherBCBS MASSACHUSETTS
MAPN0206OtherBCBS MASSACHUSETTS