MEDICARE: MS. DIANE THERESA HUSTON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	2264	CA
2	367500000X	Certified Registered Nurse Anesthetist	587291	TX
3	367500000X	Certified Registered Nurse Anesthetist	0024168557	VA

General Provider Information

NPI Number	:	1508827817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE THERESA HUSTON CRNA

Provider Business Mailing Address
First Line	:	161 ALGONQUIN RD.
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-3402
Country	:	US
Telephone Number	:	757-325-8393
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 ALGONQUIN RD.
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-3402
Country	:	US
Telephone Number	:	757-325-8393
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	05/30/2012

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