MEDICARE: MR. LEE STUART DIAMOND

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2020014400	IN

General Provider Information

NPI Number	:	1497330773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE STUART DIAMOND

Provider Business Mailing Address
First Line	:	9126 STONES BLUFF LN
Second Line	:
City	:	CAMBY
State	:	IN
Zip	:	46113-9460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3204
Country	:	US
Telephone Number	:	317-762-0190
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/17/2021

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Directions to “ MR. LEE STUART DIAMOND ” Practice Location

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