MEDICARE: MS. DIANE RENE SHEARER LPN

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
1	164W00000X	Licensed Practical Nurse	LP00021534	WA

General Provider Information

NPI Number	:	1518205525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE RENE SHEARER LPN

Provider Business Mailing Address
First Line	:	1508 E. MERCER ST.
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102
Country	:	US
Telephone Number	:	206-252-3020
Fax Number	:	206-252-3021

Provider Business Practice Location Address
First Line	:	1508 E. MERCER ST.
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102
Country	:	US
Telephone Number	:	206-252-3020
Fax Number	:	206-252-3021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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