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General NPI Number Information
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NPI Number | 1003535733
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Entity Type | Individual
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Provider Name | CASSIDY DIEDE AA
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Gender | Female
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 3601 4TH ST STOP 8182
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City | LUBBOCK
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State | TX
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Zip | 79430-8182
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Country | US
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Telephone | 806-743-2981
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 764
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City | MEAD
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State | CO
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Zip | 80542-0764
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 32698256
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License Number State | TX
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