Healthcare Provider Details

I. General information

NPI: 1922124403
Provider Name (Legal Business Name): DIANE BURICK GWIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S MERCER ST 4TH FLOOR
NEW CASTLE PA
16101-4672
US

IV. Provider business mailing address

1000 S MERCER ST 4TH FLOOR
NEW CASTLE PA
16101-4672
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-4688
  • Fax: 724-658-8810
Mailing address:
  • Phone: 724-658-4688
  • Fax: 724-658-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberRN266082L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: