Individual provider · Type 1 NPI
Laura E. Dietrich-Lake, FNP-C
Psychiatric/Mental Health Nurse Practitioner · Phoenix, AZ
NPI number
1639684046
Active
Practice location
4707 N 12th St
Phoenix, AZ 85014-4009
Fax (602) 247-9506
Mailing address
2929 E Thomas Rd
Phoenix, AZ 85016-8034
Other practice locations
- 3555 S Val Vista Dr, Gilbert, AZ 85297-7323 · (480) 728-8000
- 3555 S Val Vista Dr, Gilbert, AZ 85297-7323 · (480) 728-8000
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | AP10869 (AZ) |
| Family Nurse Practitioner | 363LF0000X | AP10869 (AZ) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
2 other providers at this address
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About NPI 1639684046
Laura E. Dietrich-Lake, FNP-C's National Provider Identifier is 1639684046, issued on Dec 7, 2017. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Phoenix, AZ. The record was last updated on Jan 27, 2026.