Provider Demographics
NPI:1457473472
Name:BAJUS, DIANE MARIE (MS, CNP, CNM, PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:BAJUS
Suffix:
Gender:F
Credentials:MS, CNP, CNM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 W DESERT COVE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5118
Mailing Address - Country:US
Mailing Address - Phone:602-579-2436
Mailing Address - Fax:602-274-0470
Practice Address - Street 1:927 W DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-579-2436
Practice Address - Fax:602-274-0470
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002216363L00000X, 367A00000X
AZAP2967367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife