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NPI Code Detail

MEDICARE: DIANA LEE MULDER CRNP

MEDICARE: DIANA LEE MULDER CRNP
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
1363L00000XNurse PractitionerCOA.10363-NPOH

General Provider Information

NPI Number : 1962403345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA LEE MULDER CRNP
Provider Business Mailing Address
First Line : 1 PERKINS SQ
Second Line :
City : AKRON
State : OH
Zip : 44308-1063
Country : US
Telephone Number : 330-729-7633
Fax Number : 330-729-7656
Provider Business Practice Location Address
First Line : 8401 MARKET ST
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-6725
Country : US
Telephone Number : 330-729-7633
Fax Number : 330-729-7656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 01/18/2016

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