Provider Demographics
NPI:1730904855
Name:STERNIN, DIANE LOUISE (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:STERNIN
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 1:1080 JULIE LN SPC 11
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6220
Mailing Address - Country:US
Mailing Address - Phone:530-417-0153
Mailing Address - Fax:
Practice Address - Street 1:1080 JULIE LN SPC 11
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6220
Practice Address - Country:US
Practice Address - Phone:530-417-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557010163W00000X, 163WH1000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice