Provider Demographics
NPI:1902317340
Name:WHITEHOUSE, DIANE LYNN
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYNN
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 BERRELL AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-1003
Mailing Address - Country:US
Mailing Address - Phone:267-625-1671
Mailing Address - Fax:
Practice Address - Street 1:2134 BERRELL AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-1003
Practice Address - Country:US
Practice Address - Phone:267-625-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program