MEDICARE: DIANE B GATLING RN-CHPN

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	163WH0200X	Home Health Registered Nurse	102139	SC

General Provider Information

NPI Number	:	1912168824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE B GATLING RN-CHPN

Provider Business Mailing Address
First Line	:	7721 BURDELL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-3907
Country	:	US
Telephone Number	:	803-695-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	7721 BURDELL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-3907
Country	:	US
Telephone Number	:	803-695-0655
Fax Number	:

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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