Basic Information
| Provider Information | |||||||||
| NPI: | 1679560494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNOCH-BOWIE | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | A.P.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 LB# 7550 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191957550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 ROUTE 23 NORTH | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HAMBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738277800 | ||||||||
| FaxNumber: | 9732097855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NN09766200 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 26NN09766200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.