Provider Demographics
NPI:1346772548
Name:AH QUIN, DYANNA
Entity Type:Individual
Prefix:
First Name:DYANNA
Middle Name:
Last Name:AH QUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:LEOLANI
Other - Last Name:AH QUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, DBH
Mailing Address - Street 1:P.O BOX 0
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:AZ
Mailing Address - Zip Code:85550
Mailing Address - Country:US
Mailing Address - Phone:928-475-1500
Mailing Address - Fax:
Practice Address - Street 1:106 MEDICINE WAY
Practice Address - Street 2:
Practice Address - City:PERIDOT
Practice Address - State:AZ
Practice Address - Zip Code:85542
Practice Address - Country:US
Practice Address - Phone:928-475-1500
Practice Address - Fax:928-475-1525
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ173331041C0700X
ND54311041C0700X, 1041C0700X
AZLMSW138331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical