Provider Demographics
NPI:1538377031
Name:DIETZ, SHARON (RN)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 DIXIE CANYON AVE
Mailing Address - Street 2:# 302
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3981
Mailing Address - Country:US
Mailing Address - Phone:818-788-1241
Mailing Address - Fax:
Practice Address - Street 1:4309 DIXIE CANYON AVE
Practice Address - Street 2:# 302
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3981
Practice Address - Country:US
Practice Address - Phone:818-788-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse