MEDICARE: DIANE HUMERICK RN

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	163W00000X	Registered Nurse	735144	TX

General Provider Information

NPI Number	:	1689491151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE HUMERICK RN

Provider Business Mailing Address
First Line	:	1921 WALTER RALEIGH
Second Line	:
City	:	WINDCREST
State	:	TX
Zip	:	78239-1858
Country	:	US
Telephone Number	:	210-488-5579
Fax Number	:	210-443-0289

Provider Business Practice Location Address
First Line	:	610 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2046
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:	210-443-0289

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

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	09/25/2024

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