Provider Demographics
NPI:1891033718
Name:WOOTEN, DYANNA
Entity Type:Individual
Prefix:MRS
First Name:DYANNA
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 E RAY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4706
Mailing Address - Country:US
Mailing Address - Phone:888-535-7341
Mailing Address - Fax:480-753-0964
Practice Address - Street 1:4302 E RAY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4706
Practice Address - Country:US
Practice Address - Phone:888-535-7341
Practice Address - Fax:480-753-0964
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator