Healthcare Provider Details

I. General information

NPI: 1295881878
Provider Name (Legal Business Name): DIANE KVAMME SIMONSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5044 N BARTON
FRESNO CA
93740-0001
US

IV. Provider business mailing address

958 ADLER DR
CLOVIS CA
93612-1503
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-2734
  • Fax:
Mailing address:
  • Phone: 559-299-8910
  • Fax: 559-278-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: