Individual
MS. DIANE R. MCNICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1425 HORSHAM RD, NORTH WALES, PA 19454-1320
(215) 371-6310
Mailing address
410 TOWER RD, SELLERSVILLE, PA 18960-3128
(215) 453-7613
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
TP005852C
PA
Other
Enumeration date
08/25/2006
Last updated
07/08/2014
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