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General NPI Number Information
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NPI Number | 1588557821
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Entity Type | Individual
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Provider Name | TINA RENEE DIES FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 127 SUNSET RIDGE RD
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City | CLYDE
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State | NC
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Zip | 28721-8597
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Country | US
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Telephone | 828-452-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 306 ELLEN AVE
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City | CANTON
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State | NC
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Zip | 28716-3584
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Country | US
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Telephone | 704-779-4974
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5022229
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License Number State | NC
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