Provider Demographics
NPI:1285606145
Name:DU PONT, DIANE HELEN (CNM)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:HELEN
Last Name:DU PONT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEMOYNE SQ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1230
Mailing Address - Country:US
Mailing Address - Phone:717-737-4511
Mailing Address - Fax:717-909-6659
Practice Address - Street 1:1 LEMOYNE SQ
Practice Address - Street 2:SUITE 201
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1230
Practice Address - Country:US
Practice Address - Phone:717-737-4511
Practice Address - Fax:717-909-6659
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008042L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3433096OtherAETNA HMO PROVIDER NUMBER
PA50026637OtherCAPITAL BLUE CROSS
PA191499OtherHIGHMARK BLUE SHIELD
PA7717165OtherAETNA PPO PROVIDER NUMBER
PA191499FQXMedicare ID - Type Unspecified
PA191499OtherHIGHMARK BLUE SHIELD