MEDICARE: DIANA FASS KRAUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R80967	SC

General Provider Information

NPI Number	:	1053754887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA FASS KRAUSE

Provider Business Mailing Address
First Line	:	6949 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1142
Country	:	US
Telephone Number	:	803-476-8309
Fax Number	:

Provider Business Practice Location Address
First Line	:	6949 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1142
Country	:	US
Telephone Number	:	803-476-8309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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Directions to “ DIANA FASS KRAUSE ” Practice Location

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