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NPI Code Detail

MEDICARE: MRS. DIANE M BYERS PA-C

MEDICARE: MRS. DIANE M BYERS PA-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
1363AM0700XMedical Physician Assistant10000747IN

General Provider Information

NPI Number : 1982686820
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE M BYERS PA-C
Provider Business Mailing Address
First Line : 2414 E STATE BLVD
Second Line : SUITE 202
City : FORT WAYNE
State : IN
Zip : 46805-4760
Country : US
Telephone Number : 260-482-4440
Fax Number : 260-482-4442
Provider Business Practice Location Address
First Line : 401 N SAWYER RD
Second Line :
City : KENDALLVILLE
State : IN
Zip : 46755-2568
Country : US
Telephone Number : 260-347-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/08/2007

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