Healthcare Provider Details

I. General information

NPI: 1528786324
Provider Name (Legal Business Name): RISING PHOENIX NATURAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CENTER AVE N
MADELIA MN
56062-1429
US

IV. Provider business mailing address

47544 105TH ST
TRUMAN MN
56088-2172
US

V. Phone/Fax

Practice location:
  • Phone: 507-412-1219
  • Fax:
Mailing address:
  • Phone: 520-227-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN P DI DIEGO
Title or Position: OWNER/PRACTITIONER
Credential: ND
Phone: 507-412-1219