Healthcare Provider Details

I. General information

NPI: 1730904855
Provider Name (Legal Business Name): DIANE LOUISE STERNIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 JULIE LN SPC 11
SOUTH LAKE TAHOE CA
96150-6220
US

IV. Provider business mailing address

1080 JULIE LN SPC 11
SOUTH LAKE TAHOE CA
96150-6220
US

V. Phone/Fax

Practice location:
  • Phone: 530-417-0153
  • Fax:
Mailing address:
  • Phone: 530-417-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number557010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number557010
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number557010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: