Provider Demographics
NPI:1326581547
Name:DINWIDDIE, SANDRA NICOLE (A-GNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:NICOLE
Last Name:DINWIDDIE
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 W CAREFREE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3202
Mailing Address - Country:US
Mailing Address - Phone:623-439-5585
Mailing Address - Fax:623-439-7775
Practice Address - Street 1:20823 N CAVE CREEK RD STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4469
Practice Address - Country:US
Practice Address - Phone:623-439-5585
Practice Address - Fax:623-439-7775
Is Sole Proprietor?:No
Enumeration Date:2016-11-19
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10488163WP0000X, 363L00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ211463Medicaid