Provider Demographics
NPI:1174877088
Name:TENNYSON, DIANA ELIZABETH (RN, FNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ELIZABETH
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:ELIZABETH
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10837 CANELO RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1902
Mailing Address - Country:US
Mailing Address - Phone:562-941-2292
Mailing Address - Fax:562-941-2292
Practice Address - Street 1:12826 PHILADELPHIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4117
Practice Address - Country:US
Practice Address - Phone:562-789-9908
Practice Address - Fax:562-789-9418
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524262; 20960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily