Basic Information
| Provider Information | |||||||||
| NPI: | 1205833233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | |||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 WATERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | PILESGROVE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080982648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567693316 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 520 S 19TH ST | ||||||||
| Address2: | STE 1B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155454173 | ||||||||
| FaxNumber: | 2155451543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN532906L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0018676340001 | 05 | PA | MEDICAID |