Provider Demographics
NPI:1376819235
Name:DIZON-DJURDJEV, NATALIE DIANE (DNP)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:DIANE
Last Name:DIZON-DJURDJEV
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:DIZON
Other - Last Name:DOHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-7500
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130679363L00000X
MARN2277680363L00000X, 363LA2200X
PASP012072363L00000X
AZAP4437363LA2200X
TX1174997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093091AMedicaid
MA110093091AMedicaid
AZZ175387Medicare PIN