Basic Information
| Provider Information | |||||||||
| NPI: | 1750323663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUTRA | ||||||||
| FirstName: | DANETTE | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5021 FLINT AVE | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932309780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595841825 | ||||||||
| FaxNumber: | 5595841825 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 GREENFIELD AVE | ||||||||
| Address2: | EMERGENCY DEPT. | ||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595829000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP9163 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.