MEDICARE: MRS. DIANE LYNN BIERKE-NELSON C.G.C.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1386633980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE LYNN BIERKE-NELSON C.G.C.

Provider Business Mailing Address
First Line	:	106 N 21ST ST E
Second Line	:
City	:	SUPERIOR
State	:	WI
Zip	:	54880-6546
Country	:	US
Telephone Number	:	218-310-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E 1ST ST # 1S3W10
Second Line	:	DULUTH CLINIC
City	:	DULUTH
State	:	MN
Zip	:	55805-1901
Country	:	US
Telephone Number	:	218-786-3012
Fax Number	:	218-786-3274

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	01/18/2011

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