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General NPI Number Information
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NPI Number | 1295862332
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Entity Type | Organization
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Legal Business Name | DIANE RAULERSONS HOME MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 2019 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6209
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Country | US
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Telephone | 912-283-4663
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Fax | 912-338-0208
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Provider Business Mailing Address
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Address Line | 2019 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6209
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Country | US
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Telephone | 912-283-4663
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Fax | 912-338-0208
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Authorized Official
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Title or Position | OWNER
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Name | MS. DIANE P RAULERSON
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Credential | RN
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Telephone | 912-283-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 002687
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 002687
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number | 002687
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License Number State | GA
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