| Organization Name: | DIANA LYNN GUMMO CRNP LLC |
| NPI Number: | 1740610583 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANA LYNN GUMMO (NURSE PRACTITIONER) |
| Mailing Address: | 607 N. Church St. Suite 2 Mt. Pleasant |
| State: | PA US |
| Postal Code: | 15666 |
| Phone Number: | 7245473200 |
| Fax Number: | 7245473210 |
| NPI Enumeration Date: | 11/14/2013 |
| NPI Last Update Date: | 11/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | SP010666 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |