Individual
MS. DIANE M. WAITKEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF PEDIATRICS, WORCESTER, MA 01655-0002
(508) 856-4155
(774) 441-8071
Mailing address
PO BOX 415348, BOSTON, MA 02241-0001
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN204637
MA
363LP0200X
Pediatric Nurse Practitioner
RN204637
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110078992A
—
MA
Enumeration date
03/28/2008
Last updated
11/09/2020
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