Provider Demographics
NPI:1811959059
Name:CARR, DIANE CLAIRE (RN, NP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CLAIRE
Last Name:CARR
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 28TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2220
Mailing Address - Country:US
Mailing Address - Phone:415-648-6253
Mailing Address - Fax:415-581-2498
Practice Address - Street 1:30 VAN NESS AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6020
Practice Address - Country:US
Practice Address - Phone:415-581-2431
Practice Address - Fax:415-581-2498
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196211OtherRN/NP LICENSE