MEDICARE: DIANE M REIMER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	131376	MA

General Provider Information

NPI Number	:	1588614689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M REIMER APRN

Provider Business Mailing Address
First Line	:	460 W MAIN ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3653
Country	:	US
Telephone Number	:	508-862-5504
Fax Number	:	508-790-3304

Provider Business Practice Location Address
First Line	:	460 W MAIN ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3653
Country	:	US
Telephone Number	:	508-862-5504
Fax Number	:	508-790-3304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/23/2017

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