Provider Demographics
NPI:1740610583
Name:DIANA LYNN GUMMO CRNP LLC
Entity Type:Organization
Organization Name:DIANA LYNN GUMMO CRNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GUMMO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-433-6134
Mailing Address - Street 1:248 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:PA
Mailing Address - Zip Code:15610-1234
Mailing Address - Country:US
Mailing Address - Phone:724-433-6134
Mailing Address - Fax:724-547-3210
Practice Address - Street 1:607 N. CHURCH ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:MT. PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-3200
Practice Address - Fax:724-547-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010666363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty