Provider Demographics
NPI:1932155231
Name:AUBREY, DIANE J (ANP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:AUBREY
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:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1019
Mailing Address - Country:US
Mailing Address - Phone:207-409-6845
Mailing Address - Fax:
Practice Address - Street 1:20 RAMSDELL RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-7757
Practice Address - Country:US
Practice Address - Phone:207-409-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP91055363LA2200X
MER031952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME289190099OtherMAINECARE
ME289190099OtherMAINECARE
S94893Medicare UPIN