Provider Demographics
NPI:1568098358
Name:HAYES, DIANE L (CRNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:HAYES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:DEARSTYNE
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:8 MEDIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3824
Mailing Address - Country:US
Mailing Address - Phone:610-247-6031
Mailing Address - Fax:
Practice Address - Street 1:240 N RADNOR CHESTER RD
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5170
Practice Address - Country:US
Practice Address - Phone:484-580-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily