Healthcare Provider Details

I. General information

NPI: 1437502200
Provider Name (Legal Business Name): DIANE SILLMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 S MACDONALD
MESA AZ
85210-1310
US

IV. Provider business mailing address

2712 E BEAUTIFUL LN
PHOENIX AZ
85042-7073
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-1471
  • Fax:
Mailing address:
  • Phone: 602-373-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN083123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: