Healthcare Provider Details

I. General information

NPI: 1982979407
Provider Name (Legal Business Name): DIANA SANDSTROM DNP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA THOMAS CRNA

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 01/09/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD POB 1, SUITE 305
CHESTER PA
19013-3955
US

IV. Provider business mailing address

30 MEDICAL CENTER BLVD POB 1, SUITE 305
CHESTER PA
19013-3955
US

V. Phone/Fax

Practice location:
  • Phone: 319-621-3840
  • Fax:
Mailing address:
  • Phone: 319-621-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR216865
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11014386
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00827
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: