Individual
DIANE D. ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYNP
Contact information
Practice address
1919 E THOMAS RD, DEPARTMENT OF OUTPATIENT PSYCHIATRY, PHOENIX, AZ 85016-7710
(602) 933-0990
(602) 933-0401
Mailing address
1919 E THOMAS RD, BLDG 2108, SUITE 101, PHOENIX, AZ 85016-7710
(602) 512-8030
(602) 512-8161
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN037283
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
548323
—
AZ
Enumeration date
09/13/2006
Last updated
01/11/2013
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