Healthcare Provider Details

I. General information

NPI: 1750784971
Provider Name (Legal Business Name): DIANE BLACKMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HORIZON DR
CHALFONT PA
18914-3950
US

IV. Provider business mailing address

PO BOX 788735
PHILADELPHIA PA
19178-8735
US

V. Phone/Fax

Practice location:
  • Phone: 215-997-9737
  • Fax: 215-997-9738
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014324
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: