Doctor Name: | IDA RENEE DIAMOND |
NPI Number: | 1083914832 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 250809 |
Business Practice Address: | 1701 W Fm 646 Rd League City, TX - 775734968 |
Business Phone Number: | 2813375430 |
Business Fax Number: | 2813375148 |
Mailing Address: | 1701 W Fm 646 Rd, LEAGUE CITY |
State: | TX |
Postal Code: | 775734968 |
Phone Number: | 2813375430 |
Fax Number: | 2813375148 |
NPI Enumeration Date: | 10/27/2010 |
NPI Last Update Date: | 10/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 250809 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |