Healthcare Provider Details

I. General information

NPI: 1942690599
Provider Name (Legal Business Name): CHRISTINE DALVA FNP, RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S DORA ST
UKIAH CA
95482-5424
US

IV. Provider business mailing address

2725 MENDOCINO AVE
SANTA ROSA CA
95403-2805
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-3996
  • Fax: 707-462-3363
Mailing address:
  • Phone: 707-545-4537
  • Fax: 707-545-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number836389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: