MEDICARE: DIANA JEAN WARD

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	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1639577968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA JEAN WARD

Provider Business Mailing Address
First Line	:	9100 W FLAMINGO RD UNIT 2023
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6404
Country	:	US
Telephone Number	:	435-990-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 W FLAMINGO RD UNIT 2023
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6404
Country	:	US
Telephone Number	:	435-990-1034
Fax Number	:

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

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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Directions to “ DIANA JEAN WARD ” Practice Location

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