Healthcare Provider Details

I. General information

NPI: 1992270193
Provider Name (Legal Business Name): DIANE M ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BENTON AVE
BENTON ME
04901-3327
US

IV. Provider business mailing address

123 CUSHMAN RD
WINSLOW ME
04901-0746
US

V. Phone/Fax

Practice location:
  • Phone: 207-453-4708
  • Fax: 207-453-6250
Mailing address:
  • Phone: 207-314-3141
  • Fax: 207-453-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN21421
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: