Provider Demographics
NPI:1396044954
Name:SHIESLEY, DIANE A (RN BSN MS FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:SHIESLEY
Suffix:
Gender:F
Credentials:RN BSN MS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 S WINDOW ROCK PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6120
Mailing Address - Country:US
Mailing Address - Phone:520-256-1781
Mailing Address - Fax:
Practice Address - Street 1:2330 S WINDOW ROCK PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6120
Practice Address - Country:US
Practice Address - Phone:520-256-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN107739163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical