Provider Demographics
NPI:1629165949
Name:GRIFFITH-PARKER, DIANE K (NMW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:GRIFFITH-PARKER
Suffix:
Gender:F
Credentials:NMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:770 MASON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4646
Practice Address - Country:US
Practice Address - Phone:707-454-5843
Practice Address - Fax:707-454-5831
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW426367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN367369Medicaid
P62520Medicare UPIN
CARN367369Medicaid
ZZZ23793ZMedicare ID - Type Unspecified