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NPI Code Detail

MEDICARE: DR. DIANA IRENE LITHGOW RN, FNP, PHD

MEDICARE: DR. DIANA IRENE LITHGOW RN, FNP, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN343032CA

General Provider Information

NPI Number : 1063634715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA IRENE LITHGOW RN, FNP, PHD
Provider Business Mailing Address
First Line : 19841 FLAGSTONE LN
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-3820
Country : US
Telephone Number : 714-962-4145
Fax Number :
Provider Business Practice Location Address
First Line : 362 3RD ST
Second Line :
City : LAGUNA BEACH
State : CA
Zip : 92651-2307
Country : US
Telephone Number : 949-494-0761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 07/08/2007

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