MEDICARE: NURSES DIVERSIFIED SYSTEMS, INC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1831710722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSES DIVERSIFIED SYSTEMS, INC

Provider Business Mailing Address
First Line	:	815 2ND AVE STE 122
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99701-4469
Country	:	US
Telephone Number	:	907-374-0852
Fax Number	:	907-374-0854

Provider Business Practice Location Address
First Line	:	219 1ST AVE S STE 310
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2551
Country	:	US
Telephone Number	:	907-374-0852
Fax Number	:	907-374-0854

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TERESA ANN BROWN LYONS
Credential	:	ANP
Telephone Number	:	907-374-0852

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	07/23/2021

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