Provider Demographics
NPI:1396917118
Name:MILLER, DIANE MARIE (FNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 COYLE AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0429
Mailing Address - Country:US
Mailing Address - Phone:916-344-9400
Mailing Address - Fax:916-344-9401
Practice Address - Street 1:5900 COYLE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0429
Practice Address - Country:US
Practice Address - Phone:916-344-9400
Practice Address - Fax:916-344-9401
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295994163WC0200X
CA8451363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine