MEDICARE: DIANA MARIE LOYNES NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	4704142535	MI

General Provider Information

NPI Number	:	1588661987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MARIE LOYNES NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	8210 KEWEENAW ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-5957
Country	:	US
Telephone Number	:	269-372-6038
Fax Number	:	269-639-8888

Provider Business Practice Location Address
First Line	:	8210 KEWEENAW ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-5957
Country	:	US
Telephone Number	:	269-372-6038
Fax Number	:	269-639-8888

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/30/2008

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