Provider Demographics
NPI:1801105127
Name:BOURNE, DIANE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:BOURNE
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 1:1865 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1431
Mailing Address - Country:US
Mailing Address - Phone:814-449-4809
Mailing Address - Fax:
Practice Address - Street 1:2620 SIGSBEE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1721
Practice Address - Country:US
Practice Address - Phone:814-454-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054518363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical