Provider Demographics
NPI:1669423349
Name:VANDERMAST, DIANA (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:VANDERMAST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04441-1129
Mailing Address - Country:US
Mailing Address - Phone:207-695-5215
Mailing Address - Fax:207-695-2329
Practice Address - Street 1:22 HALEY CT
Practice Address - Street 2:
Practice Address - City:SANGERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04479-3000
Practice Address - Country:US
Practice Address - Phone:207-876-4811
Practice Address - Fax:207-695-2329
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER048203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00796680OtherTRAVELERS MEDICARE
ME432355199Medicaid
ME434805099Medicaid
MEP00796680OtherTRAVELERS MEDICARE
Q69442Medicare UPIN
ME201826Medicare Oscar/Certification
ME201826Medicare Oscar/Certification