LAURA E DIETRICH-LAKE (NPI# 1639684046) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639684046 |
| Entity Type | Individual |
| Full Name | LAURA E DIETRICH-LAKE |
| Credential | FNP-C |
| Practice Address |
4707 N 12th St Phoenix AZ 85014-4009 |
| Mailing Address |
2929 E Thomas Rd Phoenix AZ 85016-8034 |
| Practice Telephone | 6023442506 |
| Practice Fax Number | 6022479506 |
| Mailing Telephone | 6024705000 |
| Mailing Fax Number | 6024705064 |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP10869 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3555 S Val Vista Dr, Gilbert, AZ 852977323 | 4807288000 |
| Street Address |
4707 N 12TH ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85014-4009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689764029 | Danielle Pyevich | Psychiatry & Neurology | 4707 N 12th St, Phoenix, AZ 85014-4009 | 2006-10-14 |
| 1730508524 | Maricopa County Special Health Care District | General Acute Care Hospital | 4707 N 12th St, Suite B, Phoenix, AZ 85014-4009 | 2014-04-09 |
| 1538310024 | Southwest Network | Case Management | 4707 N 12th St, Phoenix, AZ 85014-4009 | 2008-10-02 |
| 1942472170 | Jodi Erickson | Social Worker | 4707 N 12th St, Phoenix, AZ 85014-4009 | 2008-03-27 |
| 1821112129 | Magellan Health Services of Arizona, Inc. | Case Management | 4707 N 12th St, Phoenix, AZ 85014-4009 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831796549 | Sherri Ann Rhodes | Registered Nurse | 5727 North 7th Street, Suite 308, Phoenix, AZ 85014 | 2020-10-06 |
| 1235746249 | Kaitlyn Landess | Occupational Therapist | 1190 W. Missouri Ave, Suite 100, Phoenix, AZ 85014 | 2020-09-24 |
| 1467088062 | Generational Bridges Neuropsychological Services Pllc | Clinical Neuropsychologist | 1515 E Missouri Dr, Phoenix, AZ 85014 | 2020-03-16 |
| 1861022881 | Daza Astrid Hernandez | Speech-Language Pathologist | 5314 N 7th Street, Phoeniz, AZ 85014 | 2020-01-17 |
| 1396213542 | Arizona Youth & Family Services Inc. | Community/Behavioral Health | 3707 N. 7th Street, Ste. 200, Phoenix, AZ 85014 | 2018-11-06 |
| 1366815508 | Dehp LLC | Case Management | 3707 N. 7th St., Ste # 310, Phoenix, AZ 85014 | 2015-11-10 |
| 1659751972 | Carla Parola | Counselor | 1300 E Missouri Ave Ste A-120, Phoenix, AZ 85014 | 2015-06-02 |
| 1659763597 | Dale Carroll Davis | Dentist | 3132 N. 7th St, Phoenix, AZ 85014 | 2015-03-02 |
| 1407247091 | Cynthia Ruzich | Psychologist | 1450 E. Indian School Rd. #101, Phoenix, AZ 85014 | 2015-02-18 |
| 1144618315 | Emily M Bentz | Specialist/Technologist | 3514 N. 7th St, Phoenix, AZ 85014 | 2014-12-22 |
| Find all providers in zip 85014 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407456783 | Brenna Michelle Clements | Nurse Practitioner | 3226 W Donatello Dr, Phoenix, AZ 85086-2200 | 2020-10-27 |
| 1932712825 | Grace Wanjiru Karanja Adams | Nurse Practitioner | 200 E Thomas Rd Unit 217, Phoenix, AZ 85012-1182 | 2020-08-28 |
| 1649895574 | Jozzette Elaine Rubio | Nurse Practitioner | 1924 E Vineyard Rd, Phoenix, AZ 85042-5793 | 2020-06-16 |
| 1396360749 | Ulivvo Inc. | Nurse Practitioner | 141 E Palm Lane, Suite 206, Phoenix, AZ 85004 | 2020-06-11 |
| 1568087955 | Christa Ann Colvin | Nurse Practitioner | 6800 E Mayo Blvd Apt 1211, Phoenix, AZ 85054-5619 | 2020-06-10 |
| 1497378541 | Sharon Uchechi Joshua | Nurse Practitioner | 9117 W Virginia Ave, Phoenix, AZ 85037-4233 | 2020-05-23 |
| 1992326102 | Ashley Elizabeth Hall | Nurse Practitioner | 15810 N 18th St, Phoenix, AZ 85022-3302 | 2020-04-28 |
| 1750916797 | Sebastian Freeman Smith | Nurse Practitioner | 2716 W Cedarwood Ln, Phoenix, AZ 85045-2224 | 2020-03-10 |
| 1295365724 | Jessica Veasy | Nurse Practitioner | 7251 N 23rd Ave, Phoenix, AZ 85021-7714 | 2020-01-23 |
| 1568092526 | Anuradha Lingamneni | Nurse Practitioner | 2313 E Dry Wood Rd, Phoenix, AZ 85024-8688 | 2020-01-18 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.