Provider Demographics
NPI:1568518777
Name:PUTNEY, DIANE CORINNE (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CORINNE
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:133 OAK KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1850
Mailing Address - Country:US
Mailing Address - Phone:415-455-9501
Mailing Address - Fax:
Practice Address - Street 1:2550 23RD ST BLDG 92ND
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3504
Practice Address - Country:US
Practice Address - Phone:415-206-8812
Practice Address - Fax:415-647-3733
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA278435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily