Provider Demographics
NPI:1760422703
Name:DEANGELO, DIANE EVELYN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:EVELYN
Last Name:DEANGELO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:EVELYN
Other - Last Name:KING-MAIDEN UNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1110 N KIOWA ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-3381
Mailing Address - Country:US
Mailing Address - Phone:610-462-4267
Mailing Address - Fax:
Practice Address - Street 1:1230 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6367
Practice Address - Country:US
Practice Address - Phone:610-432-4529
Practice Address - Fax:610-432-2206
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008746363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1245408681OtherNPI
PA1356519847OtherNPI
PA1508034851OtherNPI
PA1811165160OtherNPI
PA1265600712OtherNPI
PA1265600712OtherNPI
PA1356519847OtherNPI
NJ096770Y4PMedicare UPIN