Basic Information
| Provider Information | |||||||||
| NPI: | 1760578256 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACYS | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 HIGHLAND AVE. | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787454489 | ||||||||
| FaxNumber: | 9783542085 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 HIGHLAND AVE. | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787454489 | ||||||||
| FaxNumber: | 9783542085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| 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 | 363L00000X | 173655 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.