MEDICARE: DR. DIANE MARIE LUTHER PH.D.

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	103TC0700X	Clinical Psychologist	00708	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36072	OTHER	IA	BCBS
2	7329033	OTHER	IA	AETNA
3	8233	OTHER	IA	MIDLANDS CHOICE

General Provider Information

NPI Number	:	1982683710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE MARIE LUTHER PH.D.

Provider Business Mailing Address
First Line	:	118 2ND ST SE
Second Line	:	SUITE 220
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-1201
Country	:	US
Telephone Number	:	319-362-0632
Fax Number	:	319-362-5206

Provider Business Practice Location Address
First Line	:	118 2ND ST SE
Second Line	:	SUITE 220
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-1201
Country	:	US
Telephone Number	:	319-362-0632
Fax Number	:	319-362-5206

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/09/2007

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