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General NPI Number Information
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NPI Number | 1962769851
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Entity Type | Individual
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Provider Name | DIANE DADDARIO
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Gender | Female
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 1100 GRAMPIAN BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1907
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Country | US
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Telephone | 570-320-7680
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP025408
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP013995
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License Number State | PA
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