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NPI Code Detail

MEDICARE: MS. DIANE GUSTAW QMHA

MEDICARE: MS. DIANE GUSTAW QMHA
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1972892792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANE GUSTAW QMHA
Provider Business Mailing Address
First Line : 8777 W MAULE AVE
Second Line : 2074
City : LAS VEGAS
State : NV
Zip : 89148-4868
Country : US
Telephone Number : 631-839-2462
Fax Number :
Provider Business Practice Location Address
First Line : 8777 W MAULE AVENUE
Second Line : 2074
City : LAS VEGAS
State : NV
Zip : 89148-4894
Country : US
Telephone Number : 631-839-2462
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2011
Last Update Date : 04/01/2011

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Directions to “ MS. DIANE GUSTAW QMHA” Practice Location

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