Healthcare Provider Details

I. General information

NPI: 1508002080
Provider Name (Legal Business Name): DIANA M MOYERS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD SUITE 105 B
COLUMBUS OH
43220-2553
US

IV. Provider business mailing address

5151 REED RD SUITE 105 B
COLUMBUS OH
43220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-2306
  • Fax: 614-884-0776
Mailing address:
  • Phone: 614-457-2306
  • Fax: 614-884-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number081647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: