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General NPI Number Information
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NPI Number | 1255484952
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Entity Type | Individual
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Provider Name | DIANE B LUEDTKE CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 211 N 12TH ST
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City | LEHIGHTON
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State | PA
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Zip | 18235-1138
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Country | US
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Telephone | 570-401-3960
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Fax | 570-325-8336
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Provider Business Mailing Address
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Address Line | 9 WHITE LN
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City | JIM THORPE
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State | PA
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Zip | 18229-1022
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Country | US
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Telephone | 570-325-4170
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Fax | 570-325-8336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | TP006236C
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | TP006235H
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License Number State | PA
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