MEDICARE: DIANE MARIE BOYER

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	251E00000X	Home Health Agency	739433	AK
2	310400000X	Assisted Living Facility		AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730388190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE MARIE BOYER

Provider Business Mailing Address
First Line	:	PO BOX 520983
Second Line	:
City	:	BIG LAKE
State	:	AK
Zip	:	99652
Country	:	US
Telephone Number	:	907-892-0794
Fax Number	:	907-892-0795

Provider Business Practice Location Address
First Line	:	11269 WEST WASEY WAY
Second Line	:
City	:	HOUSTON
State	:	AK
Zip	:	99694
Country	:	US
Telephone Number	:	907-892-0794
Fax Number	:	907-892-0795

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS DIANE MARIE BOYER
Credential	:
Telephone Number	:	907-892-0794

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	08/06/2008

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