Provider Demographics
NPI:1043229883
Name:BURT, DIANE M (RN, MSN, APN-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BURT
Suffix:
Gender:F
Credentials:RN, MSN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:765 E ROUTE 70
Mailing Address - Street 2:BLD A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-797-4751
Mailing Address - Fax:856-797-4791
Practice Address - Street 1:265 IRVING AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2121
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-453-8495
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN097238363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification