Provider Demographics
NPI:1972873784
Name:NURSES DIVERSIFIED SYSTEMS, INC
Entity Type:Organization
Organization Name:NURSES DIVERSIFIED SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-750-8114
Mailing Address - Street 1:PO BOX 72376
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-2376
Mailing Address - Country:US
Mailing Address - Phone:907-750-8114
Mailing Address - Fax:
Practice Address - Street 1:815 2ND AVE STE 122
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4469
Practice Address - Country:US
Practice Address - Phone:907-374-0852
Practice Address - Fax:907-374-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty