Provider Demographics
NPI:1326371972
Name:SMYK, DIANE J
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:J
Last Name:SMYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 PINE LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1314
Mailing Address - Country:US
Mailing Address - Phone:610-385-3864
Mailing Address - Fax:610-933-4080
Practice Address - Street 1:1288 VALLEY FORGE RD
Practice Address - Street 2:UNIT 69
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2687
Practice Address - Country:US
Practice Address - Phone:610-933-9483
Practice Address - Fax:610-933-4080
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN070999L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse