Provider Demographics
NPI:1144399387
Name:NEDDENRIEP, DIANE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:NEDDENRIEP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5155 E FARNESS DR
Mailing Address - Street 2:STE. 111A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2158
Mailing Address - Country:US
Mailing Address - Phone:520-327-1787
Mailing Address - Fax:520-321-9613
Practice Address - Street 1:5155 E FARNESS DR
Practice Address - Street 2:STE. 111A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2158
Practice Address - Country:US
Practice Address - Phone:520-327-1787
Practice Address - Fax:520-321-9613
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ174282080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ277998Medicaid