Provider Demographics
NPI:1306547757
Name:GEORGETTI, DIANNE GRACE (NP)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:GRACE
Last Name:GEORGETTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 PARNASSUS AVE STE 908
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3612
Mailing Address - Country:US
Mailing Address - Phone:415-353-2119
Mailing Address - Fax:415-353-2406
Practice Address - Street 1:350 PARNASSUS AVE STE 908
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3612
Practice Address - Country:US
Practice Address - Phone:415-353-2119
Practice Address - Fax:415-353-2406
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022480363LG0600X
CA706152163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management