Individual
DIAMOND TIEA FERN COURVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN- FNP-C
Contact information
Practice address
143 GARDEN HOMES DR, COLVILLE, WA 99114-9229
(509) 684-3701
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
75755
MT
363LF0000X
Family Nurse Practitioner
Primary
AP61591647
WA
363LP2300X
Primary Care Nurse Practitioner
NUR-APRN-LIC-239199
MT
Other
Enumeration date
05/29/2018
Last updated
09/27/2024
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