Provider Demographics
NPI:1750784971
Name:BLACKMAN, DIANE (CRNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 SWAMP RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-9663
Mailing Address - Country:US
Mailing Address - Phone:215-230-8380
Mailing Address - Fax:215-230-8370
Practice Address - Street 1:5039 SWAMP RD STE 401
Practice Address - Street 2:
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9663
Practice Address - Country:US
Practice Address - Phone:215-230-8380
Practice Address - Fax:215-230-8370
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2014022540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily