Provider Demographics
NPI:1093814592
Name:MYERS, DIANE (RN, MSN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ANDREAS ESTATES PL
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9321
Mailing Address - Country:US
Mailing Address - Phone:831-768-1101
Mailing Address - Fax:
Practice Address - Street 1:1701 ANDREAS ESTATES PL
Practice Address - Street 2:
Practice Address - City:ROYAL OAKS
Practice Address - State:CA
Practice Address - Zip Code:95076-9321
Practice Address - Country:US
Practice Address - Phone:831-768-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health