MEDICARE: MARIAN SUE DIAMOND FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP1345	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437139474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN SUE DIAMOND FNP

Provider Business Mailing Address
First Line	:	1200 N BEAVER ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3118
Country	:	US
Telephone Number	:	928-213-6235
Fax Number	:	928-213-6292

Provider Business Practice Location Address
First Line	:	61 BELL ROCK PLZ
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86351-8810
Country	:	US
Telephone Number	:	928-204-4999
Fax Number	:	928-204-4990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/25/2021

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