Basic Information
| Provider Information | |||||||||
| NPI: | 1518022110 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RNC, ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 ALGIRD ST. | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026581952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 TIMBER LN | ||||||||
| Address2: | |||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054037205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028474714 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 101-0015614 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1005734 | 05 | VT | MEDICAID |