Provider Demographics
NPI:1689659310
Name:WENTLING, DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WENTLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 EAST NORTH AVENUE
Mailing Address - Street 2:LEVEL ONE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-325-5500
Mailing Address - Fax:
Practice Address - Street 1:314 E NORTH AVE
Practice Address - Street 2:LEVEL ONE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-325-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004536363A00000X
PAMA054463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002723161OtherHIGHMARK MEDICARE ADVANTAGE
PAPO1714755OtherRAILROAD MEDICARE
PA103187944Medicaid
PA002723161OtherHIGHMARK MEDICARE ADVANTAGE