Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | LM-0000160 | DE |
Y | 363L00000X | Nurse Practitioner | VP003505J | PA |
N | 363LN0000X | Nurse Practitioner - Neonatal | VP003505J | PA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | VP003505J | PA |
NPI | 1104901289 |
---|---|
Provider Name | Ms. Diane M. Travlos |
First Address | Rockland, DE 19732-0191 |
Second Address | Philadelphia, PA 19107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0021679 | (05) | NJ |
4039068 | (05) | MD |
S68451 | (02) |