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General NPI Number Information
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NPI Number | 1598918492
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Entity Type | Individual
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Provider Name | DIANA V NETCHAEVA NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 5800 GRANITE PKWY STE 820 SUITE 104
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City | PLANO
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State | TX
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Zip | 75024-6612
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Country | US
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Telephone | 808-544-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 GRANITE PKWY STE 820 SUITE 104
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City | PLANO
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State | TX
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Zip | 75024-6612
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Country | US
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Telephone | 808-544-8833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 642846
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License Number State | TX
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