Provider Demographics
NPI:1679351985
Name:DAMON-HORSTMAN, DIANE MARIE (ARDMS)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:DAMON-HORSTMAN
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:DAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDMS, RT(R), M
Mailing Address - Street 1:7489 E LAS PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-5599
Mailing Address - Country:US
Mailing Address - Phone:602-510-4186
Mailing Address - Fax:
Practice Address - Street 1:500 N STATE ROUTE 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313-5001
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1771852085R0202X
AZ933062085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology