Provider Demographics
NPI:1205024148
Name:GARDINER, DIANA DEINAROWICZ (CRNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DEINAROWICZ
Last Name:GARDINER
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 1:235 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3519
Mailing Address - Country:US
Mailing Address - Phone:215-829-6700
Mailing Address - Fax:
Practice Address - Street 1:235 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3519
Practice Address - Country:US
Practice Address - Phone:215-829-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008504363LF0000X
NJ26NJ00372200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily