Provider Demographics
NPI:1639661838
Name:DINER, CAREY ANNE (RN)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ANNE
Last Name:DINER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5365 ROYAL BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-1408
Mailing Address - Country:US
Mailing Address - Phone:682-225-9329
Mailing Address - Fax:
Practice Address - Street 1:5365 ROYAL BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-1408
Practice Address - Country:US
Practice Address - Phone:682-225-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX922694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse