Healthcare Provider Details

I. General information

NPI: 1891033718
Provider Name (Legal Business Name): MRS. DYANNA WOOTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 E RAY RD SUITE 107
PHOENIX AZ
85044-4706
US

IV. Provider business mailing address

4302 E RAY RD SUITE 107
PHOENIX AZ
85044-4706
US

V. Phone/Fax

Practice location:
  • Phone: 888-535-7341
  • Fax: 480-753-0964
Mailing address:
  • Phone: 888-535-7341
  • Fax: 480-753-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: