Healthcare Provider Details

I. General information

NPI: 1043983919
Provider Name (Legal Business Name): NILDA MARIE FIMBRES RN CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 N ARIZOLA RD
CASA GRANDE AZ
85122-6011
US

IV. Provider business mailing address

PO BOX 10097
CASA GRANDE AZ
85130-0020
US

V. Phone/Fax

Practice location:
  • Phone: 520-381-0395
  • Fax: 520-381-3204
Mailing address:
  • Phone: 520-836-3446
  • Fax: 520-381-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number20620498
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN041442
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: