Provider Demographics
NPI:1750323663
Name:DUTRA, DANETTE K (NP)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:K
Last Name:DUTRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-9780
Mailing Address - Country:US
Mailing Address - Phone:559-584-1825
Mailing Address - Fax:559-584-1825
Practice Address - Street 1:450 GREENFIELD AVE
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3513
Practice Address - Country:US
Practice Address - Phone:559-582-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9163363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner