Provider Demographics
NPI:1588349518
Name:WILKES UNIVERSITY
Entity type:Organization
Organization Name:WILKES UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:570-408-4730
Mailing Address - Street 1:84 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18766-0997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:84 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18766-0997
Practice Address - Country:US
Practice Address - Phone:570-408-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty