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NPI Code Detail

MEDICARE: DIANE M. NITTA M.D.

MEDICARE: DIANE M. NITTA M.D.
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
1208000000XPediatrics Physician100939MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316033194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE M. NITTA M.D.
Provider Business Mailing Address
First Line : PO BOX 505673
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-5673
Country : US
Telephone Number : 417-730-6430
Fax Number : 417-269-7567
Provider Business Practice Location Address
First Line : 3443 S NATIONAL AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-7308
Country : US
Telephone Number : 417-269-2000
Fax Number : 417-269-2038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 05/14/2024

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