Healthcare Provider Details

I. General information

NPI: 1568317857
Provider Name (Legal Business Name): JAIME NICOLE KUBEHL-DYKEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24017 N 35TH DR
GLENDALE AZ
85310-4165
US

IV. Provider business mailing address

24017 N 35TH DR
GLENDALE AZ
85310-4165
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number337291
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAZ136727
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: