Provider Demographics
NPI:1750351672
Name:LYTLE, DIANNE HOLLIS (CNM)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:HOLLIS
Last Name:LYTLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:ROGERS
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-0128
Mailing Address - Country:US
Mailing Address - Phone:207-244-4049
Mailing Address - Fax:
Practice Address - Street 1:10 WAYMAN LANE
Practice Address - Street 2:MT DESERT ISLAND HOSPITAL & HEALTH CENTERS
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609
Practice Address - Country:US
Practice Address - Phone:207-288-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008100L176B00000X
MER018721367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered176B00000XOther Service ProvidersMidwife
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
R56497Medicare UPIN
PA191601ESCMedicare ID - Type Unspecified