Healthcare Provider Details

I. General information

NPI: 1437395209
Provider Name (Legal Business Name): DIANA LYNN SCANLAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 09/02/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 ROUTE 31 SUITE 108
CLINTON NJ
08807
US

IV. Provider business mailing address

1738 ROUTE 31 SUITE 108
CLINTON NJ
08809-3158
US

V. Phone/Fax

Practice location:
  • Phone: 908-735-3980
  • Fax: 908-735-3981
Mailing address:
  • Phone: 908-735-3980
  • Fax: 908-735-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00168200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: