Healthcare Provider Details

I. General information

NPI: 1841782265
Provider Name (Legal Business Name): DIANA OLIVERA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 E MCDOWELL RD STE A
PHOENIX AZ
85006-2603
US

IV. Provider business mailing address

7030 W PONTIAC DR
GLENDALE AZ
85308-9450
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8588
  • Fax: 602-688-6991
Mailing address:
  • Phone: 623-208-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number182604
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07180341
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: