Healthcare Provider Details

I. General information

NPI: 1578612230
Provider Name (Legal Business Name): DIANE MARIE HANNAFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E 1ST ST SUITE100
SANTA ANA CA
92701-6341
US

IV. Provider business mailing address

1540 E 1ST ST SUITE100
SANTA ANA CA
92701-6341
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-8003
  • Fax:
Mailing address:
  • Phone: 714-972-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number580367
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number580367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: