Provider Demographics
NPI:1205295748
Name:DEAB, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DEAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-2154
Mailing Address - Country:US
Mailing Address - Phone:978-995-4125
Mailing Address - Fax:
Practice Address - Street 1:51 5TH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-2154
Practice Address - Country:US
Practice Address - Phone:978-995-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT5935183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT5935OtherCOMMONWEALTH OF MASSACHUSETTS
NHPT10199OtherSTATE OF NEW HAMPSHIRE