Provider Demographics
NPI:1376886135
Name:WILLIAMS, DIANE M (CSFA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSFA
Mailing Address - Street 1:6336 N ORACLE RD # 326245
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5480
Mailing Address - Country:US
Mailing Address - Phone:520-204-1629
Mailing Address - Fax:520-204-1629
Practice Address - Street 1:6336 N ORACLE RD # 326245
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5480
Practice Address - Country:US
Practice Address - Phone:520-204-1629
Practice Address - Fax:520-204-1629
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant