Healthcare Provider Details

I. General information

NPI: 1003292293
Provider Name (Legal Business Name): DIANA PAOLA HARRISON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412-22 FAIRMOUNT AVE
PHILADELPHIA PA
19130
US

IV. Provider business mailing address

1412 22 FAIRMOUNT AVENUE
PHILADELPHIA PA
19130-2908
US

V. Phone/Fax

Practice location:
  • Phone: 215-599-4851
  • Fax:
Mailing address:
  • Phone: 215-599-4851
  • Fax: 215-232-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015136
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: