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General NPI Number Information
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NPI Number | 1770074478
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Entity Type | Individual
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Provider Name | DIAMOND TIEA FERN COURVILLE APRN- FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 143 GARDEN HOMES DR
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City | COLVILLE
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State | WA
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Zip | 99114-9229
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Country | US
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Telephone | 509-684-3701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 421
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-0421
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61591647
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 75755
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NUR-APRN-LIC-239199
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License Number State | MT
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