Provider Demographics
NPI:1407817133
Name:WADLUND, DIANA L (RN CRNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:WADLUND
Suffix:
Gender:F
Credentials:RN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-436-6529
Mailing Address - Fax:610-436-6479
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:MOB III, SUITE 332
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-647-3077
Practice Address - Fax:610-993-0668
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN254020L363L00000X
PASP004767M363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S49711Medicare UPIN
PA005178M10Medicare ID - Type Unspecified