Healthcare Provider Details

I. General information

NPI: 1053329482
Provider Name (Legal Business Name): DIANE M PRICE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR 4
LEBANON NH
03756-1000
US

IV. Provider business mailing address

21 SPENCER ST APT 205
LEBANON NH
03766-6317
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 315-527-6178
  • Fax: 603-727-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF302200-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number071559-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0113503
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: