Provider Demographics
NPI:1437139474
Name:DIAMOND, MARIAN SUE (FNP)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:SUE
Last Name:DIAMOND
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 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:61 BELL ROCK PLZ
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8810
Practice Address - Country:US
Practice Address - Phone:928-204-4999
Practice Address - Fax:928-204-4990
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ585474Medicaid
AZP36122Medicare UPIN
AZ585474Medicaid