Provider Demographics
NPI:1801957766
Name:DICCION, BERNADETTE B (CRNP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:B
Last Name:DICCION
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:DIPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:680 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2223
Mailing Address - Country:US
Mailing Address - Phone:215-264-9826
Mailing Address - Fax:
Practice Address - Street 1:8811 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2718
Practice Address - Country:US
Practice Address - Phone:215-248-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008479363LF0000X, 363LF0000X
NJ26NJ00129800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110759XVAMedicare PIN
PAQ45329Medicare UPIN
PA091617Medicare PIN