MEDICARE: MRS. DIANA MARY EASTON MPAS, PA-C

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	363AM0700X	Medical Physician Assistant	MA001008L	PA

General Provider Information

NPI Number	:	1750557591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA MARY EASTON MPAS, PA-C

Provider Business Mailing Address
First Line	:	1000 MEADE ST STE 202
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-3197
Country	:	US
Telephone Number	:	570-342-0800
Fax Number	:	570-696-1200

Provider Business Practice Location Address
First Line	:	1000 MEADE ST STE 202
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-3197
Country	:	US
Telephone Number	:	570-342-0800
Fax Number	:	570-696-1200

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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