Provider Demographics
NPI:1427045418
Name:CARDWELL, DIANE M (PA-C, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:PA-C, ARNP
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:HERMESCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5745
Mailing Address - Country:US
Mailing Address - Phone:515-239-2155
Mailing Address - Fax:515-239-2050
Practice Address - Street 1:1214 S GRANT RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3102
Practice Address - Country:US
Practice Address - Phone:712-792-7500
Practice Address - Fax:712-792-7510
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000847363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS73564Medicare UPIN
IAI21855Medicare PIN