| Doctor Name: | DIANE M BURT |
| NPI Number: | 1043229883 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, MSN, APN-C |
| License Number: | 26NN097238 |
| Business Practice Address: | 265 Irving Ave Bridgeton, NJ - 083022121 |
| Business Phone Number: | 8564514700 |
| Business Fax Number: | 8564538495 |
| Mailing Address: | 765 E Route 70, Bld A MARLTON |
| State: | NJ |
| Postal Code: | 080532341 |
| Phone Number: | 8567974751 |
| Fax Number: | 8567974791 |
| NPI Enumeration Date: | 08/07/2006 |
| NPI Last Update Date: | 04/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 26NN097238 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |