MEDICARE: DIANE PURCELL CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	RN190819L	PA

General Provider Information

NPI Number	:	1417039181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE PURCELL CRNP

Provider Business Mailing Address
First Line	:	2085 N 63RD STREET
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19151
Country	:	US
Telephone Number	:	215-452-0304
Fax Number	:	215-452-0311

Provider Business Practice Location Address
First Line	:	2085 N 63RD STREET
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19151
Country	:	US
Telephone Number	:	215-452-0304
Fax Number	:	215-452-0311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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