Individual
LAURA E DIETRICH-LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
4707 N 12TH ST, PHOENIX, AZ 85014-4009
(602) 344-2506
(602) 247-9506
Mailing address
2929 E THOMAS RD, PHOENIX, AZ 85016-8034
(602) 470-5000
(602) 470-5064
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP10869
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP10869
AZ
Other
Enumeration date
12/07/2017
Last updated
01/27/2026
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