MEDICARE: MRS. DIANA EVERITT R.N.

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	RN047842	AZ

General Provider Information

NPI Number	:	1770816563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA EVERITT R.N.

Provider Business Mailing Address
First Line	:	7139 S 10TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5522
Country	:	US
Telephone Number	:	602-232-4233
Fax Number	:

Provider Business Practice Location Address
First Line	:	7139 S 10TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5522
Country	:	US
Telephone Number	:	602-232-4233
Fax Number	:

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

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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