Individual
DIANE PETROVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
75 PINEAPPLE STREET, BLACK CREEK HEALTH CENTER, NUREMBERG, PA 18241-0670
(570) 384-3201
(570) 384-3454
Mailing address
1084 ROUTE 315, WILKES-BARRE, PA 18702-7012
(570) 825-8741
(570) 825-8990
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA000042L
PA
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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