Provider Demographics
NPI:1740329697
Name:MUNROE, DEANNE CAROL (NP)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:CAROL
Last Name:MUNROE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:CAROL
Other - Last Name:DALPHOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1611 BIRCHCREST CIR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-1813
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-789-4468
Practice Address - Street 1:12462 PUTNAM ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1048
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-789-4468
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190745363LA2200X
CA95002191363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health