Provider Demographics
NPI:1922085422
Name:ROCHE, DIANE (CNM)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIGHWAY 191 AND HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-7001
Mailing Address - Fax:928-674-7707
Practice Address - Street 1:HIGHWAY 191 AND HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:928-674-7707
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3509176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife