Healthcare Provider Details

I. General information

NPI: 1972971844
Provider Name (Legal Business Name): DIANE T FREDERICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 NEW CASTLE RD
BUTLER PA
16001-2576
US

IV. Provider business mailing address

3600 FORBES AVE
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 724-283-3627
  • Fax:
Mailing address:
  • Phone: 412-432-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015164
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number125969
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: