Provider Demographics
NPI:1598129132
Name:ONTKEAN, DARSHEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:DARSHEL
Middle Name:
Last Name:ONTKEAN
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 1:24451 LEAFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4155
Mailing Address - Country:US
Mailing Address - Phone:951-473-7381
Mailing Address - Fax:951-893-5131
Practice Address - Street 1:25405 HANCOCK AVE STE 216
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5978
Practice Address - Country:US
Practice Address - Phone:951-200-6481
Practice Address - Fax:951-893-5131
Is Sole Proprietor?:No
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner