Healthcare Provider Details

I. General information

NPI: 1922926187
Provider Name (Legal Business Name): HEIDI LYNNE DIEDIKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI CLITES RN

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16440 S 32ND ST
PHOENIX AZ
85048-7807
US

IV. Provider business mailing address

2736 E ROCKLEDGE RD
PHOENIX AZ
85048-8902
US

V. Phone/Fax

Practice location:
  • Phone: 605-929-0601
  • Fax:
Mailing address:
  • Phone: 605-929-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number322801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: