Provider Demographics
NPI:1528299229
Name:PARTNER, DWIGHT THOMAS (NURSE PRACTIONER)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:THOMAS
Last Name:PARTNER
Suffix:
Gender:M
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 WILSHIRE BLVD
Mailing Address - Street 2:F297
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3435
Mailing Address - Country:US
Mailing Address - Phone:323-830-1475
Mailing Address - Fax:
Practice Address - Street 1:19353 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-6302
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily