Provider Demographics
NPI:1013943323
Name:FEENEY, DIANNE M (NP)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:FEENEY
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:206 MILL RD
Practice Address - Street 2:SOUTHCOAST PHYSICIANS GROUP, INC.
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5252
Practice Address - Country:US
Practice Address - Phone:508-973-3000
Practice Address - Fax:508-973-3057
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA177291363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0330175Medicaid
MANP2810Medicare ID - Type UnspecifiedB