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NPI Code Detail

MEDICARE: CAROLYN DIMICELI

MEDICARE: CAROLYN DIMICELI
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
1363LP0200XPediatric Nurse Practitioner259820AZ
2363L00000XNurse Practitioner259820AZ

Other Identifiers

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

General Provider Information

NPI Number : 1356911994
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN DIMICELI
Provider Business Mailing Address
First Line : 4434 N 12TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4507
Country : US
Telephone Number : 602-242-5121
Fax Number : 602-242-6945
Provider Business Practice Location Address
First Line : 4434 N 12TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4507
Country : US
Telephone Number : 602-242-5121
Fax Number : 602-242-6945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2021
Last Update Date : 06/27/2025

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Directions to “ CAROLYN DIMICELI ” Practice Location

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