MEDICARE: MS. DIANN ROSELLEN DEUTSCH R.N.

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	28172915A	IN

General Provider Information

NPI Number	:	1134319437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANN ROSELLEN DEUTSCH R.N.

Provider Business Mailing Address
First Line	:	2220 DALE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-1604
Country	:	US
Telephone Number	:	260-747-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 DALE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-1604
Country	:	US
Telephone Number	:	260-747-8289
Fax Number	:

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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