Provider Demographics
NPI:1285794008
Name:TRAPP, DAIANA E (PTMS)
Entity type:Individual
Prefix:MRS
First Name:DAIANA
Middle Name:E
Last Name:TRAPP
Suffix:
Gender:F
Credentials:PTMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-0668
Mailing Address - Country:US
Mailing Address - Phone:928-524-2123
Mailing Address - Fax:
Practice Address - Street 1:800 N APACHE AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-3819
Practice Address - Country:US
Practice Address - Phone:928-288-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6211021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ811738Medicaid