Provider Demographics
NPI:1003170440
Name:BONE, DIANA SUN (FNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:SUN
Last Name:BONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 W MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5002
Mailing Address - Country:US
Mailing Address - Phone:602-334-3586
Mailing Address - Fax:
Practice Address - Street 1:9947 WEST HAPPY VALLEY PARKWAY
Practice Address - Street 2:# 104
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-6001
Practice Address - Country:US
Practice Address - Phone:623-434-5748
Practice Address - Fax:623-566-9665
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4539363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP4539OtherNP LICENSE