MEDICARE: MRS. HOPE DIANE LIEN BD

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	374J00000X	Doula

General Provider Information

NPI Number	:	1831490382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOPE DIANE LIEN BD

Provider Business Mailing Address
First Line	:	4031 BETHEL DR
Second Line	:	APT.#31
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-6951
Country	:	US
Telephone Number	:	651-398-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	4031 BETHEL DR
Second Line	:	APT.#31
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-6951
Country	:	US
Telephone Number	:	651-398-0775
Fax Number	:

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

Provider Enumeration Date	:	11/14/2010
Last Update Date	:	11/14/2010

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