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General NPI Number Information
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NPI Number | 1952092991
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Entity Type | Organization
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Legal Business Name | DIABETES RN LLC
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 755 E 11TH AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-3641
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Country | US
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Telephone | 385-242-6729
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Fax |
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Provider Business Mailing Address
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Address Line | 755 E 11TH AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-3641
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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 | CREDENTIALING MANAGER
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Name | JADE GIANAKOPOULOS
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Credential |
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Telephone | 937-206-0377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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