Provider Demographics
NPI:1053695395
Name:NEMIROVSKY, DIANA (CNM)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NEMIROVSKY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-3977
Mailing Address - Fax:510-204-5429
Practice Address - Street 1:2450 ASHBY AVE RM 3040
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-204-3977
Practice Address - Fax:510-204-5429
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA753612163W00000X, 163W00000X
CA21112363L00000X
CA1963367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1963OtherAMCB
OR500645761Medicaid
ORR167530OtherPTAN
CA21112OtherCALIFORNIA BOARD OF NURSING
CA753612OtherBOARD OF NURSING