MEDICARE: DANA DIBLASI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	RN330027L	PA

General Provider Information

NPI Number	:	1215664560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA DIBLASI RN

Provider Business Mailing Address
First Line	:	124 HAWS LANE
Second Line	:	FLOURTOWN, PA 19031
City	:	FLOURTOWN
State	:	PA
Zip	:	19031
Country	:	US
Telephone Number	:	215-834-8385
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-4015
Country	:	US
Telephone Number	:	215-400-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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