Provider Demographics
NPI:1316682263
Name:DIWAN, MRUNMAYI (PA-C)
Entity type:Individual
Prefix:
First Name:MRUNMAYI
Middle Name:
Last Name:DIWAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 UNIVERSITY DR BLDG 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:
Practice Address - Street 1:4705 UNIVERSITY DR BLDG 700
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3489
Practice Address - Country:US
Practice Address - Phone:919-237-1337
Practice Address - Fax:919-237-1625
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12334363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant