Active NPI
Diane M Vandover, NP
- Nurse Practitioner
- Boston, MA
National Provider Identifier
1316991854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 193344
- Practice address
- 88 E Newton St
Special Procedures- Boston Medical Center
Boston, MA 02118-2308 - Phone
- (617) 838-6642
- Fax
- (617) 414-8801
- NPI assigned
- May 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 193344 | MA | Primary |
Addresses
Primary practice location
88 E Newton St
Special Procedures- Boston Medical Center
Boston, MA 02118-2308
Mailing address
88 E Newton St
Special Procedures- Boston Medical Center
Boston, MA 02118-2308
Phone (617) 838-6642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0349160 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 193344 | MA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316991854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "88 E NEWTON ST",
"address_2": "SPECIAL PROCEDURES- BOSTON MEDICAL CENTER",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182308",
"telephone_number": "617-838-6642",
"fax_number": "617-414-8801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "88 E NEWTON ST",
"address_2": "SPECIAL PROCEDURES- BOSTON MEDICAL CENTER",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182308",
"telephone_number": "617-838-6642",
"fax_number": "617-414-8801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDOVER",
"first_name": "DIANE",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "193344",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0349160",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.