Provider Demographics
NPI:1669502571
Name:MITCHELL, DIANE HOOKE (ANP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HOOKE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 FOREST ST.
Practice Address - Street 2:
Practice Address - City:BABSON PARK
Practice Address - State:MA
Practice Address - Zip Code:02457
Practice Address - Country:US
Practice Address - Phone:781-239-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152892363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health