Healthcare Provider Details

I. General information

NPI: 1366407116
Provider Name (Legal Business Name): DIANE S VON GERICHTEN RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

3703 BARN VIEW PL
DURHAM NC
27705-1344
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-416-5857
Mailing address:
  • Phone: 919-286-0411
  • Fax: 919-416-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85689
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: