Provider Demographics
NPI:1073615191
Name:HANLON, DIANE KERSHOW (CRNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KERSHOW
Last Name:HANLON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 QUEEN ANNE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2824
Mailing Address - Country:US
Mailing Address - Phone:410-643-3328
Mailing Address - Fax:
Practice Address - Street 1:201 W PRESTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2301
Practice Address - Country:US
Practice Address - Phone:410-767-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO76919363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRO76919OtherNURSING LICENSE