Healthcare Provider Details

I. General information

NPI: 1013130921
Provider Name (Legal Business Name): DIANE MARIE POULIN RN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST NEWTON WELLESLEY HOSPITAL DEPT. OF ANESTHESIA
NEWTON MA
02462-1607
US

IV. Provider business mailing address

2014 WASHINGTON ST NEWTON WELLESLEY HOSPITAL DEPT. OF ANESTHESIA
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6298
  • Fax: 617-243-6184
Mailing address:
  • Phone: 617-243-6298
  • Fax: 617-243-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number127457
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: