Provider Demographics
NPI:1366467979
Name:NORRBY, DIANE (PA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:NORRBY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31325 VIA LA NARANGA
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9614
Mailing Address - Country:US
Mailing Address - Phone:831-659-3284
Mailing Address - Fax:831-659-3284
Practice Address - Street 1:3150 LENOX PARK BLVD STE 214
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4396
Practice Address - Country:US
Practice Address - Phone:901-273-2368
Practice Address - Fax:901-273-2351
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11807363AM0700X
CA134386364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40248FMedicaid
CAPA11807Medicare UPIN
CAHSP40248FMedicaid
CAZZZ93296ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY NMC