Provider Demographics
NPI:1043317241
Name:DREW, DIANE (PA-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1042
Mailing Address - Country:US
Mailing Address - Phone:603-448-0447
Mailing Address - Fax:603-448-1089
Practice Address - Street 1:106 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1042
Practice Address - Country:US
Practice Address - Phone:603-448-0447
Practice Address - Fax:603-448-1089
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30330772Medicaid
NHS84257Medicare UPIN
NH30330772Medicaid