Healthcare Provider Details

I. General information

NPI: 1568518777
Provider Name (Legal Business Name): DIANE CORINNE PUTNEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 23RD ST BLDG 92ND
SAN FRANCISCO CA
94110-3504
US

IV. Provider business mailing address

133 OAK KNOLL AVE
SAN ANSELMO CA
94960-1850
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8812
  • Fax: 415-647-3733
Mailing address:
  • Phone: 415-455-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number278435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: