Individual
MS. DIANE M VANDOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
88 E NEWTON ST, SPECIAL PROCEDURES- BOSTON MEDICAL CENTER, BOSTON, MA 02118-2308
(617) 838-6642
(617) 414-8801
Mailing address
88 E NEWTON ST, SPECIAL PROCEDURES- BOSTON MEDICAL CENTER, BOSTON, MA 02118-2308
(617) 838-6642
(617) 414-8801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
193344
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0349160
—
MA
Enumeration date
05/20/2006
Last updated
07/08/2007
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