Healthcare Provider Details

I. General information

NPI: 1881674596
Provider Name (Legal Business Name): DIANNE J. DEVOLL ALDRICH FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL ATTN PROFESSIONAL AFFAIRS MAGTFTC MCAGCC BOX 788250
TWENTYNINE PALMS CA
92278-8250
US

IV. Provider business mailing address

3072 LEJEUNE CIR
TWENTYNINE PALMS CA
92277-9440
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2188
  • Fax: 760-830-2179
Mailing address:
  • Phone: 760-368-9829
  • Fax: 760-830-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN23341
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00081
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP22341
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: