Provider Demographics
NPI:1235167164
Name:DILLER, AMIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:AMIE
Middle Name:
Last Name:DILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 BUCKLEBURY RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3089
Mailing Address - Country:US
Mailing Address - Phone:530-750-3760
Mailing Address - Fax:
Practice Address - Street 1:1207 FAIRCHILD CT
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4321
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:530-661-2410
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNM1174367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04003ZMedicare ID - Type Unspecified
CAQ69418Medicare UPIN