Healthcare Provider Details

I. General information

NPI: 1245419548
Provider Name (Legal Business Name): DIANE ELAINE KNUDSEN DHA, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 FAIR ST
BLOOMSBURG PA
17815-1419
US

IV. Provider business mailing address

100 N ACADEMY AVE # 4903
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 570-387-2111
  • Fax: 570-387-2245
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP009385
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00303600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301792
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012241
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP012241
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: