MEDICARE: DIANE M BERKEY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	061074	IA
2	367500000X	Certified Registered Nurse Anesthetist	D061074	IA
3	367500000X	Certified Registered Nurse Anesthetist	045177	IL

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	:	1881676534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M BERKEY CRNA

Provider Business Mailing Address
First Line	:	1112 N JEFFERSON AVE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2034
Country	:	US
Telephone Number	:	641-424-6704
Fax Number	:	641-424-6709

Provider Business Practice Location Address
First Line	:	1410 6TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4818
Country	:	US
Telephone Number	:	641-424-6704
Fax Number	:	641-424-6709

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	02/08/2010

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Directions to “ DIANE M BERKEY CRNA” Practice Location

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