Provider Demographics
NPI:1841502804
Name:SMITH, DIANE JEAN (ADULT NURSE PRACTITI)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MELROSE ST.
Mailing Address - Street 2:NAME: CONCENTRA
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901
Mailing Address - Country:US
Mailing Address - Phone:401-784-7579
Mailing Address - Fax:401-784-7305
Practice Address - Street 1:280 MELROSE ST.
Practice Address - Street 2:NAME: CONCENTRA
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02901
Practice Address - Country:US
Practice Address - Phone:401-784-7579
Practice Address - Fax:401-784-7305
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP22524363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner