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NPI Code Detail

MEDICARE: DIANE L WATERS APN

MEDICARE: DIANE L WATERS APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerIL

General Provider Information

NPI Number : 1396705638
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE L WATERS APN
Provider Business Mailing Address
First Line : COLLEGE AND UNIVERSITY-2540
Second Line :
City : NORMAL
State : IL
Zip : 61790-2540
Country : US
Telephone Number : 309-438-2956
Fax Number : 309-438-3689
Provider Business Practice Location Address
First Line : COLLEGE AND UNIVERSITY-2540
Second Line :
City : NORMAL
State : IL
Zip : 61790-2540
Country : US
Telephone Number : 309-438-2956
Fax Number : 309-438-3689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 03/07/2023

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