Basic Information
| Provider Information | |||||||||
| NPI: | 1740329697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNROE | ||||||||
| FirstName: | DEANNE | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DALPHOND | ||||||||
| OtherFirstName: | DEANNE | ||||||||
| OtherMiddleName: | CAROL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1611 BIRCHCREST CIR | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928211813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5627894468 | ||||||||
| Practice Location | |||||||||
| Address1: | 12462 PUTNAM ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906021048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5627894468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 12/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 190745 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | 95002191 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.