MEDICARE: MARISSA LAURA DIORIO FNP-C CRNP

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	363LF0000X	Family Nurse Practitioner	SP033506	PA
2	363L00000X	Nurse Practitioner	SP033506	PA

General Provider Information

NPI Number	:	1952273906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LAURA DIORIO FNP-C CRNP

Provider Business Mailing Address
First Line	:	3803 W CHESTER PIKE STE 160
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2336
Country	:	US
Telephone Number	:	610-645-6555
Fax Number	:	610-649-4744

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE
Second Line	:	SUITE 330 MOB WEST
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3450
Country	:	US
Telephone Number	:	610-645-6555
Fax Number	:	610-649-4744

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

Provider Enumeration Date	:	09/19/2025
Last Update Date	:	01/09/2026

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