Provider Demographics
NPI:1891892576
Name:DALTON, DIANE IRENE (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:IRENE
Last Name:DALTON
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 1:14937 SHERMAN WAY APT 14
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2185
Mailing Address - Country:US
Mailing Address - Phone:818-994-8584
Mailing Address - Fax:310-268-3366
Practice Address - Street 1:14937 SHERMAN WAY APT 14
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2185
Practice Address - Country:US
Practice Address - Phone:818-994-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 13266363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner