Healthcare Provider Details

I. General information

NPI: 1801957766
Provider Name (Legal Business Name): BERNADETTE B DICCION CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNADETTE DIPPLE CRNP

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

IV. Provider business mailing address

680 BLAIR MILL RD
HORSHAM PA
19044-2223
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8252
  • Fax:
Mailing address:
  • Phone: 215-264-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008479
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: