Provider Demographics
NPI:1720699788
Name:SANDRA DINWIDDIE NP
Entity Type:Organization
Organization Name:SANDRA DINWIDDIE NP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DINWIDDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-439-5585
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty