Individual
DIEM VO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2555 JIMMY JOHNSON BLVD, PORT ARTHUR, TX 77640-2007
(409) 724-7389
Mailing address
4410 INDIAN FALL DR, PORT ARTHUR, TX 77642-2175
(409) 365-2140
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1002047
TX
Other
Enumeration date
04/13/2020
Last updated
01/07/2021
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