Healthcare Provider Details

I. General information

NPI: 1235866773
Provider Name (Legal Business Name): DIVYA NALLI PMHNP-BC, FNP-C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 MAIN ST
NEWMAN CA
95360-1326
US

IV. Provider business mailing address

1001 BLUE RANGE WAY
ROSEVILLE CA
95747-4497
US

V. Phone/Fax

Practice location:
  • Phone: 209-862-3604
  • Fax:
Mailing address:
  • Phone: 916-776-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022030
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95022030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: