Provider Demographics
NPI:1386615151
Name:SEIPEL SHERARD, DIANE (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SEIPEL SHERARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:E
Other - Last Name:SEIPEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNNP
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-4508
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252796363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN252796Medicaid
CA252796OtherB.R.N.
CA1133OtherB.R.N.
CA1133OtherB.R.N.
CARN252796Medicaid
CA1133OtherB.R.N.