MEDICARE: MS. DIANE H CUMMINGS CNP

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	363LF0000X	Family Nurse Practitioner	R47159	NM
2	367A00000X	Advanced Practice Midwife	508	NM
3	363L00000X	Nurse Practitioner	CNP1154	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538149190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE H CUMMINGS CNP

Provider Business Mailing Address
First Line	:	80 B VETERANS BLVD
Second Line	:
City	:	ACOMA
State	:	NM
Zip	:	87034
Country	:	US
Telephone Number	:	505-552-5300
Fax Number	:	505-552-5490

Provider Business Practice Location Address
First Line	:	7801 ACADEMY RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3379
Country	:	US
Telephone Number	:	505-272-2700
Fax Number	:	505-272-6308

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	11/14/2017

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