Individual
CAROLYN DIMICELI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4434 N 12TH ST, PHOENIX, AZ 85014-4507
(602) 242-5121
(602) 242-6945
Mailing address
4434 N 12TH ST, PHOENIX, AZ 85014-4507
(602) 242-5121
(602) 242-6945
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
259820
AZ
363LP0200X
Pediatric Nurse Practitioner
259820
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104847
—
AZ
Enumeration date
06/27/2021
Last updated
06/27/2025
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