MEDICARE: MRS. DIANA WEGNER NP-C

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	363LA2200X	Adult Health Nurse Practitioner	537308	TX

General Provider Information

NPI Number	:	1568449452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA WEGNER NP-C

Provider Business Mailing Address
First Line	:	8841 MARAUDER DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4187
Country	:	US
Telephone Number	:	281-974-8530
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 BEECHNUT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-4302
Country	:	US
Telephone Number	:	713-456-8188
Fax Number	:	713-448-8045

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	04/04/2016

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