MEDICARE: MS. DIANE E. NASH ANGEL M.A.

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1134477474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE E. NASH ANGEL M.A.

Provider Business Mailing Address
First Line	:	6032 CALLE DIEZ NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-5705
Country	:	US
Telephone Number	:	505-604-8775
Fax Number	:

Provider Business Practice Location Address
First Line	:	6032 CALLE DIEZ NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-5705
Country	:	US
Telephone Number	:	505-604-8775
Fax Number	:

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

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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