Provider Demographics
NPI:1235866773
Name:NALLI, DIVYA (PMHNP-BC, FNP-C, MSN)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:NALLI
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BLUE RANGE WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4497
Mailing Address - Country:US
Mailing Address - Phone:916-776-3584
Mailing Address - Fax:
Practice Address - Street 1:1349 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1326
Practice Address - Country:US
Practice Address - Phone:209-862-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022030363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily