MEDICARE: DIANE M. KENDALL APRN, BC

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	363L00000X	Nurse Practitioner	212106-4405	UT

General Provider Information

NPI Number	:	1659397545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M. KENDALL APRN, BC

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-954-7672
Fax Number	:	801-501-4099

Provider Business Practice Location Address
First Line	:	1403 E SEGO LILY DR STE 100
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4350
Country	:	US
Telephone Number	:	801-265-2212
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	06/07/2024

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