Healthcare Provider Details

I. General information

NPI: 1871881581
Provider Name (Legal Business Name): DIANA HOLBEIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA MARUCCI CRNP

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CARDIAC CARE UNIT
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD CARDIAC CARE UNIT
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 215-590-6690
Mailing address:
  • Phone: 215-590-1000
  • Fax: 215-590-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9335360
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00335200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP014659
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: