Provider Demographics
NPI:1205833233
Name:MURRAY, DIANE (CRNA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PILESGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-2648
Mailing Address - Country:US
Mailing Address - Phone:856-769-3316
Mailing Address - Fax:
Practice Address - Street 1:520 S 19TH ST
Practice Address - Street 2:STE 1B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1449
Practice Address - Country:US
Practice Address - Phone:215-545-4173
Practice Address - Fax:215-545-1543
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN532906L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018676340001Medicaid
PA054207Medicare ID - Type Unspecified