Provider Demographics
NPI:1508854639
Name:SANDEL, DIANNE H (FNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:H
Last Name:SANDEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:H
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16773 BERNARDO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2509
Mailing Address - Country:US
Mailing Address - Phone:760-221-4823
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:16773 BERNARDO CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2509
Practice Address - Country:US
Practice Address - Phone:760-221-4823
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP51627Medicare UPIN
CA3505011Medicare ID - Type Unspecified