Healthcare Provider Details

I. General information

NPI: 1982089215
Provider Name (Legal Business Name): DYANNA MARIE HARRISON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

9807 E LARKSPUR DR
SCOTTSDALE AZ
85260-5145
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-5501
  • Fax:
Mailing address:
  • Phone: 480-330-2109
  • Fax: 480-968-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8002
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP8002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: