Healthcare Provider Details

I. General information

NPI: 1831674647
Provider Name (Legal Business Name): REBECCA C DIAMOND NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BRIDGE ST STE 9
CONCORD NH
03301-4922
US

IV. Provider business mailing address

24 BRIDGE ST STE 9
CONCORD NH
03301-4922
US

V. Phone/Fax

Practice location:
  • Phone: 603-415-0090
  • Fax: 833-944-2250
Mailing address:
  • Phone: 603-415-0090
  • Fax: 833-944-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number059653-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: