Provider Demographics
NPI:1861146177
Name:HANLON, DIANE A (PFT, CHC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:HANLON
Suffix:
Gender:F
Credentials:PFT, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 N MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1117
Mailing Address - Country:US
Mailing Address - Phone:570-814-9212
Mailing Address - Fax:
Practice Address - Street 1:54 N MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1117
Practice Address - Country:US
Practice Address - Phone:570-814-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach