Provider Demographics
NPI:1063634715
Name:LITHGOW, DIANA IRENE (RN, FNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:IRENE
Last Name:LITHGOW
Suffix:
Gender:F
Credentials:RN, FNP, PHD
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:I
Other - Last Name:GEORGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:19841 FLAGSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3820
Mailing Address - Country:US
Mailing Address - Phone:714-962-4145
Mailing Address - Fax:
Practice Address - Street 1:362 3RD ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2307
Practice Address - Country:US
Practice Address - Phone:949-494-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN343032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily