Basic Information
| Provider Information | |||||||||
| NPI: | 1750351672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYTLE | ||||||||
| FirstName: | DIANNE | ||||||||
| MiddleName: | HOLLIS | ||||||||
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| Credential: | CNM | ||||||||
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| OtherLastName: | LYTLE | ||||||||
| OtherFirstName: | DIANNE | ||||||||
| OtherMiddleName: | ROGERS | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 128 | ||||||||
| Address2: | |||||||||
| City: | MOUNT DESERT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046600128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072444049 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 WAYMAN LANE | ||||||||
| Address2: | MT DESERT ISLAND HOSPITAL & HEALTH CENTERS | ||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072885081 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| 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 | 176B00000X | MW008100L | PA | X | Other Service Providers | Midwife | 367A00000X | R018721 | ME | X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.