Provider Demographics
NPI:1477696417
Name:KEYES, DIANE MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:KEYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:638 CAMINO DE LOS MARES
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2848
Mailing Address - Country:US
Mailing Address - Phone:949-487-9791
Mailing Address - Fax:
Practice Address - Street 1:638 CAMINO DE LOS MARES
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2848
Practice Address - Country:US
Practice Address - Phone:949-487-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404421163W00000X
CA7592363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner