Provider Demographics
NPI:1518370519
Name:DIMOND, DENA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:NICOLE
Last Name:DIMOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 SONOMA AVE
Mailing Address - Street 2:STE 119
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4812
Mailing Address - Country:US
Mailing Address - Phone:707-544-3811
Mailing Address - Fax:707-544-0128
Practice Address - Street 1:1144 SONOMA AVE
Practice Address - Street 2:STE 119
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4812
Practice Address - Country:US
Practice Address - Phone:707-544-3811
Practice Address - Fax:707-544-0128
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA133739Medicare PIN