Healthcare Provider Details

I. General information

NPI: 1568098358
Provider Name (Legal Business Name): DIANE L. HAYES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE DEARSTYNE HAYES CRNP

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N RADNOR CHESTER RD
RADNOR PA
19087-5170
US

IV. Provider business mailing address

8 MEDIA AVE
HAVERTOWN PA
19083-3824
US

V. Phone/Fax

Practice location:
  • Phone: 484-580-1200
  • Fax:
Mailing address:
  • Phone: 610-247-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021663
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: