Provider Demographics
NPI:1326588344
Name:IVERSON, DAYNA (FNP, RN)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:IVERSON
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S OAK AVE
Mailing Address - Street 2:BLDG 2, STE 1
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3528
Mailing Address - Country:US
Mailing Address - Phone:209-848-8410
Mailing Address - Fax:209-848-0732
Practice Address - Street 1:190 S OAK AVE
Practice Address - Street 2:BLDG 2, STE 1
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3528
Practice Address - Country:US
Practice Address - Phone:209-848-8410
Practice Address - Fax:209-848-0732
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95119825163W00000X
CA95011857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95119825OtherREGISTER NURSE
CA95011857OtherNURSE PRACTITIONER