Healthcare Provider Details

I. General information

NPI: 1952592602
Provider Name (Legal Business Name): DAWN MARIE DIAZ WHNP OR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 EAST INDIAN SCHOOL PARK SUITE 130 GYNECOLOGIC SOLUTIONS
PHOENIX AZ
85016-6872
US

IV. Provider business mailing address

3102 EAST INDIAN SCHOOL PARK SUITE 130
PHOENIX AZ
85016-6872
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-0202
  • Fax: 602-424-2053
Mailing address:
  • Phone: 602-252-0202
  • Fax: 602-424-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN131993
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP2110
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: