Individual
DIANE HERMANIE MAINWOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1318 S PINE ST, MELBOURNE, FL 32901-3117
(321) 952-9500
(321) 952-2299
Mailing address
114 ISLAND VIEW DR, INDIAN HARBOUR BEACH, FL 32937-4346
(321) 777-5442
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
OS6956
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070207200
—
FL
Enumeration date
09/08/2005
Last updated
09/25/2014
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