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Organization
INNOVATIVE DIABETIC CENTER, LLC
Active
Organization
INNOVATIVE DIABETIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY LORRAINE HUNN (PRESIDENT)
(480) 493-0900
Entity
Organization
Contact information
Practice address
10210 N 92ND ST STE 104, SCOTTSDALE, AZ 85258-4531
(480) 493-0900
(833) 228-0846
Mailing address
10210 N 92ND ST STE 104, SCOTTSDALE, AZ 85258-4531
(480) 493-0900
(833) 228-0846
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
NULL
133N00000X
Nutritionist
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
NULL
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
163WD0400X
Diabetes Educator Registered Nurse
—
NULL
163WD0400X
Diabetes Educator Registered Nurse
—
—
163WI0500X
Infusion Therapy Registered Nurse
—
NULL
163WI0500X
Infusion Therapy Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
NULL
164W00000X
Licensed Practical Nurse
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/11/2024
Last updated
12/31/2025
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