Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP4539 | AZ |
NPI | 1003170440 |
---|---|
Provider Name | Diana Sun Bone |
First Address | Peoria, AZ 85383-5002 |
Second Address | Peoria, AZ 85383-6001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 29/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP4539 | NP LICENSE (01) | AZ |