Healthcare Provider Details

I. General information

NPI: 1992062772
Provider Name (Legal Business Name): DIANE M WORLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 500
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-3900
  • Fax:
Mailing address:
  • Phone: 571-777-5102
  • Fax: 703-563-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN326150L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: