Healthcare Provider Details

I. General information

NPI: 1427597996
Provider Name (Legal Business Name): DIANNA CORDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N SIERRA MADRE ST
MOUNTAIN HOUSE CA
95391-1142
US

IV. Provider business mailing address

129 N SIERRA MADRE ST
MOUNTAIN HOUSE CA
95391-1142
US

V. Phone/Fax

Practice location:
  • Phone: 510-599-0649
  • Fax:
Mailing address:
  • Phone: 510-599-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number718898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: