MEDICARE: MINDY DIEHL FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	271716	AZ

General Provider Information

NPI Number	:	1174270193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY DIEHL FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1808
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-1808
Country	:	US
Telephone Number	:	928-649-6477
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 S MAIN ST
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-7155
Country	:	US
Telephone Number	:	928-649-6477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	03/11/2022

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Directions to “ MINDY DIEHL FNP-C” Practice Location

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