Provider Demographics
NPI:1811069628
Name:WREN, DIANE LINDA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LINDA
Last Name:WREN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42104 N VENTURE DR
Mailing Address - Street 2:SUITE D118
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3823
Mailing Address - Country:US
Mailing Address - Phone:623-505-6565
Mailing Address - Fax:623-551-5567
Practice Address - Street 1:7609 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE C-9
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3415
Practice Address - Country:US
Practice Address - Phone:480-585-0095
Practice Address - Fax:480-585-0185
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN132776363LF0000X
AZAP2193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002057Medicaid
AZ002057Medicaid
P57107Medicare UPIN