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General NPI Number Information
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NPI Number | 1467655092
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Entity Type | Individual
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Provider Name | DIANE ELIZABETH KENNEDY N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2007
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE SUITE 455
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-556-0536
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Fax |
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Provider Business Mailing Address
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Address Line | 11180 WARNER AVE SUITE 455
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-556-0536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | NP7672
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License Number State | CA
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