MEDICARE: SANDRA DINWIDDIE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WP0000X	Pain Management Registered Nurse
2	363LA2200X	Adult Health Nurse Practitioner
3	363LG0600X	Gerontology Nurse Practitioner
4	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1720699788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA DINWIDDIE

Provider Business Mailing Address
First Line	:	20823 N CAVE CREEK RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-4469
Country	:	US
Telephone Number	:	623-439-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	20823 N CAVE CREEK RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-4469
Country	:	US
Telephone Number	:	623-439-5585
Fax Number	:	623-439-7775

Authorized Official
Title or Position	:	OWNER
Name	:	SANDRA NICOLE DINWIDDIE
Credential	:
Telephone Number	:	623-439-5585

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	06/01/2026

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