Provider Demographics
NPI:1275515306
Name:DETERMAN, DANA GEORGE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:GEORGE
Last Name:DETERMAN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5596 W CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2714
Mailing Address - Country:US
Mailing Address - Phone:559-275-4722
Mailing Address - Fax:
Practice Address - Street 1:4785 N 1ST ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0513
Practice Address - Country:US
Practice Address - Phone:559-448-4745
Practice Address - Fax:559-448-4740
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN506592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner