Provider Demographics
NPI:1457653768
Name:NETEMEYER, DISA (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:DISA
Middle Name:
Last Name:NETEMEYER
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 PACKARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7117
Mailing Address - Country:US
Mailing Address - Phone:530-749-6329
Mailing Address - Fax:
Practice Address - Street 1:5730 PACKARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7117
Practice Address - Country:US
Practice Address - Phone:530-749-6329
Practice Address - Fax:530-749-6397
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA775928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse