Healthcare Provider Details

I. General information

NPI: 1841905726
Provider Name (Legal Business Name): DIANA LORINE BARNES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 W HEATHERBRAE DR STE A
PHOENIX AZ
85015-4764
US

IV. Provider business mailing address

1847 W HEATHERBRAE DR
PHOENIX AZ
85015-4764
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-2100
  • Fax:
Mailing address:
  • Phone: 602-274-2100
  • Fax: 602-535-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number285560
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: