Provider Demographics
NPI:1982979407
Name:SANDSTROM, DIANA (DNP CRNA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:DNP CRNA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:30 MEDICAL CENTER BLVD
Mailing Address - Street 2:POB 1, SUITE 305
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3955
Mailing Address - Country:US
Mailing Address - Phone:319-621-3840
Mailing Address - Fax:
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:POB 1, SUITE 305
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:319-621-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216865367500000X
FLAPRN11014386367500000X
DEL6-0A00827367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered