Provider Demographics
NPI:1447276886
Name:RAYMOND, DIANNE JEAN (PMH-NP, DSN)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:JEAN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PMH-NP, DSN
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:JEAN
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0569
Mailing Address - Country:US
Mailing Address - Phone:207-864-2699
Mailing Address - Fax:207-864-2969
Practice Address - Street 1:4 CLEMENT WAY
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-4370
Practice Address - Country:US
Practice Address - Phone:207-495-3323
Practice Address - Fax:207-495-3353
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER025851363LP0808X
MEAP081135163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432406999Medicaid
ME432406999Medicaid