Provider Demographics
NPI:1336474840
Name:SIM, DIANNE M (RN)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:SIM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2202
Mailing Address - Country:US
Mailing Address - Phone:510-222-8403
Mailing Address - Fax:888-711-6364
Practice Address - Street 1:2675 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2202
Practice Address - Country:US
Practice Address - Phone:510-222-8403
Practice Address - Fax:888-711-6364
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344586163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator