MEDICARE: DIANA POLIMINE NURSE PRACTICIONER

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	00501613	NC

General Provider Information

NPI Number	:	1861511511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA POLIMINE NURSE PRACTICIONER

Provider Business Mailing Address
First Line	:	720 COOL SPRINGS BLVD
Second Line	:	SUITE 300
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2626
Country	:	US
Telephone Number	:	615-778-4066
Fax Number	:	615-778-9114

Provider Business Practice Location Address
First Line	:	5400 S MIAMI BLVD
Second Line	:	SUITE 112
City	:	DURHAM
State	:	NC
Zip	:	27703-8465
Country	:	US
Telephone Number	:	615-778-4066
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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