Healthcare Provider Details

I. General information

NPI: 1487189056
Provider Name (Legal Business Name): DIANE PENG GREENBERG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 3RD ST
WILLIAMSPORT PA
17701-5316
US

IV. Provider business mailing address

501 E 3RD ST
WILLIAMSPORT PA
17701-5316
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-7535
  • Fax:
Mailing address:
  • Phone: 570-323-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017320
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP026661
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN634572
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: