Provider Demographics
NPI:1659332146
Name:DANDURAND, JOANN (FNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:DANDURAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR
Mailing Address - Street 2:#304
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2580
Mailing Address - Country:US
Mailing Address - Phone:707-643-6483
Mailing Address - Fax:707-643-3028
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:#304
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2580
Practice Address - Country:US
Practice Address - Phone:707-643-6483
Practice Address - Fax:707-643-3028
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMD0505529OtherDEA
CAMD0505529OtherDEA