Healthcare Provider Details

I. General information

NPI: 1962738765
Provider Name (Legal Business Name): DIANE ZAMESKA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 COTTMAN AVE
PHILADELPHIA PA
19149-1230
US

IV. Provider business mailing address

9401 EVANS ST
PHILADELPHIA PA
19115-4314
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-0603
  • Fax:
Mailing address:
  • Phone: 215-805-6736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: