Healthcare Provider Details

I. General information

NPI: 1114919818
Provider Name (Legal Business Name): SHELLEY BRINKMAN DIEHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 S GRANT RD
CARROLL IA
51401-3102
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-1500
  • Fax:
Mailing address:
  • Phone: 515-239-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001284
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: