Healthcare Provider Details

I. General information

NPI: 1972018067
Provider Name (Legal Business Name): ASHLEY DIANE CARDWELL MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S GREENFIELD RD STE 102
GILBERT AZ
85296-4012
US

IV. Provider business mailing address

888 S GREENFIELD RD STE 102
GILBERT AZ
85296-4012
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-0700
  • Fax: 480-507-7477
Mailing address:
  • Phone: 480-507-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10833
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: