MEDICARE: DIANE CLAIRE CARR RN, NP

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	363L00000X	Nurse Practitioner	196211	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196211	OTHER	CA	RN/NP LICENSE

General Provider Information

NPI Number	:	1811959059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE CLAIRE CARR RN, NP

Provider Business Mailing Address
First Line	:	552 28TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2220
Country	:	US
Telephone Number	:	415-648-6253
Fax Number	:	415-581-2498

Provider Business Practice Location Address
First Line	:	30 VAN NESS AVE
Second Line	:	SUITE 2300
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-6020
Country	:	US
Telephone Number	:	415-581-2431
Fax Number	:	415-581-2498

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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