Healthcare Provider Details

I. General information

NPI: 1972607018
Provider Name (Legal Business Name): DIANE KAUFMAN PETERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVENUE
MEMPHIS TN
38104
US

IV. Provider business mailing address

3246 BRAKEBILL CV
MEMPHIS TN
38116-3006
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-4900
  • Fax:
Mailing address:
  • Phone: 901-550-2337
  • Fax: 901-332-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0000005250
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: