Provider Demographics
NPI:1659461796
Name:SCHERMERHORN, DIANNE M (RNP BC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:SCHERMERHORN
Suffix:
Gender:F
Credentials:RNP BC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP BC
Mailing Address - Street 1:PO BOX 1413
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667
Mailing Address - Country:US
Mailing Address - Phone:508-240-0208
Mailing Address - Fax:508-240-0499
Practice Address - Street 1:3130 STATE HIGHWAY ROUTE 6
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667
Practice Address - Country:US
Practice Address - Phone:508-349-3131
Practice Address - Fax:508-349-1311
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1084Medicare ID - Type Unspecified
MAS55233Medicare UPIN