MEDICARE: DIANA KATHLEEN SCHAEFFER APRN-CNP

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	163WG0000X	General Practice Registered Nurse	41846	OK

General Provider Information

NPI Number	:	1497083612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA KATHLEEN SCHAEFFER APRN-CNP

Provider Business Mailing Address
First Line	:	5809 NW 103RD PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6969
Country	:	US
Telephone Number	:	405-603-3779
Fax Number	:

Provider Business Practice Location Address
First Line	:	5809 NW 103RD PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6969
Country	:	US
Telephone Number	:	405-603-3779
Fax Number	:

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

Provider Enumeration Date	:	11/29/2009
Last Update Date	:	12/02/2011

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