Healthcare Provider Details

I. General information

NPI: 1629390778
Provider Name (Legal Business Name): DIANE LABBAN F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE LABAN F.N.P

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CHANDLER BLVD STE 308 #308
PHOENIX AZ
85048-7646
US

IV. Provider business mailing address

4545 E CHANDLER BLVD STE 308 #308
PHOENIX AZ
85048-7646
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-2100
  • Fax:
Mailing address:
  • Phone: 480-893-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3516
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: