Individual
MRS. DIANE JEAN MACMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-8366
(215) 707-1649
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-8366
(215) 707-1649
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
TP-004421-C
PA
363LF0000X
Family Nurse Practitioner
26NN07392400
NJ
Other
Enumeration date
10/30/2008
Last updated
02/18/2010
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