=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396846978
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE NACHAMKIN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 OLD LANCASTER RD STE 105N
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-527-1165
-----------------------------------------------------
Fax | 610-527-6611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 OLD LANCASTER RD STE 105N
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-527-1165
-----------------------------------------------------
Fax | 610-527-6611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN251489L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | VP004015P
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------