Provider Demographics
NPI:1992815450
Name:HOULE, DIANA (PA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HOULE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16947 W CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1926
Mailing Address - Country:US
Mailing Address - Phone:623-215-8140
Mailing Address - Fax:757-490-9401
Practice Address - Street 1:16430 W YUMA RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3102
Practice Address - Country:US
Practice Address - Phone:623-465-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084679Medicaid
970013900OtherMEDICARE RAILROAD
970000363Medicare ID - Type Unspecified
VA008928398Medicaid