Provider Demographics
NPI:1710067525
Name:BURCHARD, DIANNA
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:BURCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:BURCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2980 W WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-7615
Mailing Address - Country:US
Mailing Address - Phone:520-586-2330
Mailing Address - Fax:520-586-2330
Practice Address - Street 1:2980 W WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-7615
Practice Address - Country:US
Practice Address - Phone:520-586-2330
Practice Address - Fax:520-586-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8445385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child