Provider Demographics
NPI:1689633356
Name:EASTMAN, DIANE (CNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:RT. 6 TOWN PLAZA
Practice Address - Street 2:SUITE 2
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-836-4294
Practice Address - Fax:570-836-7709
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008339363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02679252Medicaid
PAP00362289OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
PAGU039862OtherMEDICARE GROUP
PA095001N89Medicare PIN
Q53433Medicare UPIN