Healthcare Provider Details

I. General information

NPI: 1659408235
Provider Name (Legal Business Name): DIANE F CLINTON APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MARSHALL RD
LOWELL MA
01852-5130
US

IV. Provider business mailing address

130 MARSHALL RD
LOWELL MA
01852-5130
US

V. Phone/Fax

Practice location:
  • Phone: 978-671-9160
  • Fax:
Mailing address:
  • Phone: 978-671-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN137269
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number137269
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: