Healthcare Provider Details

I. General information

NPI: 1285187260
Provider Name (Legal Business Name): MARIANNA DILOYAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ROOSEVELT BLVD SUITE 206
PHILADELPHIA PA
19114-1025
US

IV. Provider business mailing address

9501 ROOSEVELT BLVD SUITE 206
PHILADELPHIA PA
19114-1025
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-8900
  • Fax: 215-671-1272
Mailing address:
  • Phone: 215-671-8900
  • Fax: 215-671-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN618691
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP016276
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: