MEDICARE: SANDRA NICOLE DINWIDDIE A-GNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0000X	Pain Management Registered Nurse	AP10488	AZ
2	363L00000X	Nurse Practitioner	AP10488	AZ
3	363LG0600X	Gerontology Nurse Practitioner	AP10488	AZ
4	363LA2200X	Adult Health Nurse Practitioner	AP10488	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326581547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA NICOLE DINWIDDIE A-GNP

Provider Business Mailing Address
First Line	:	3120 W CAREFREE HWY STE 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-3202
Country	:	US
Telephone Number	:	623-439-5585
Fax Number	:	623-439-7775

Provider Business Practice Location Address
First Line	:	20823 N CAVE CREEK RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-4469
Country	:	US
Telephone Number	:	623-439-5585
Fax Number	:	623-439-7775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2016
Last Update Date	:	09/30/2020

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