Provider Demographics
NPI:1164628251
Name:WIELAND, DIANE MARIE (RN)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:WIELAND
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 1:329 W MAIN ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2066
Mailing Address - Country:US
Mailing Address - Phone:215-362-5594
Mailing Address - Fax:215-362-5596
Practice Address - Street 1:329 W MAIN ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2066
Practice Address - Country:US
Practice Address - Phone:215-362-5594
Practice Address - Fax:215-362-5596
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN205871L163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult