Provider Demographics
NPI:1598145146
Name:DAVIDSON, DIANA (NP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:NP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RACE ST APT 11E
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2038
Mailing Address - Country:US
Mailing Address - Phone:215-872-0127
Mailing Address - Fax:
Practice Address - Street 1:315 OLD LANDING RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-1210
Practice Address - Country:US
Practice Address - Phone:302-353-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9339588363LP0808X
PASP017910363LP0808X
DEL8-0000187363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health