Healthcare Provider Details

I. General information

NPI: 1417024795
Provider Name (Legal Business Name): DIANNE JEAN SCHROCK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 MOSSIDE BLVD
MONROEVILLE PA
15146-2760
US

IV. Provider business mailing address

3431 GREENVILLE RD
MEYERSDALE PA
15552-8403
US

V. Phone/Fax

Practice location:
  • Phone: 412-357-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP008613
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN545743
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: