Provider Demographics
NPI:1245578525
Name:DIERKS, LYNN M (ACNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:DIERKS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:SPIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:13555 W MCDOWELL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2626
Mailing Address - Country:US
Mailing Address - Phone:623-215-5933
Mailing Address - Fax:
Practice Address - Street 1:13555 W MCDOWELL RD STE 205
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2626
Practice Address - Country:US
Practice Address - Phone:623-227-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013477363LA2100X
AZAP4782363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care