Provider Demographics
NPI:1518678788
Name:DIZON, DWANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DWANNE
Middle Name:
Last Name:DIZON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5197 MORNING GLORY CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7431
Mailing Address - Country:US
Mailing Address - Phone:909-910-3974
Mailing Address - Fax:
Practice Address - Street 1:5197 MORNING GLORY CT
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-7431
Practice Address - Country:US
Practice Address - Phone:909-910-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily