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General NPI Number Information
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NPI Number | 1740610583
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Entity Type | Organization
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Legal Business Name | DIANA LYNN GUMMO CRNP LLC
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 607 N. CHURCH ST. SUITE 2
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City | MT. PLEASANT
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State | PA
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Zip | 15666
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Country | US
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Telephone | 724-547-3200
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Fax | 724-547-3210
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Provider Business Mailing Address
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Address Line | 248 GREENBRIER RD
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City | ACME
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State | PA
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Zip | 15610-1234
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Country | US
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Telephone | 724-433-6134
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Fax | 724-547-3210
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. DIANA LYNN GUMMO
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Credential | CRNP
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Telephone | 724-433-6134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP010666
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License Number State | PA
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