Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RNP223586 | AZ |
N | 363LA2100X | Nurse Practitioner - Acute Care | RNP223586 | AZ |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RNP223586 | AZ |
N | 363LG0600X | Nurse Practitioner - Gerontology | RNP223586 | AZ |
NPI | 1063975076 |
---|---|
Provider Name | Diana Thayer |
First Address | Phoenix, AZ 85016-7767 |
Second Address | Phoenix, AZ 85016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2019 |
Last Update Date | 29/08/2019 |