Individual
DIANA MANIS FICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2421 W 21ST ST STE B, GENERAL SURGERY - CLOVIS, CLOVIS, NM 88101-2006
(575) 769-7577
(575) 742-7856
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2025-0155
NM
363AS0400X
Surgical Physician Assistant
Primary
PA2025-0155
NM
Other
Enumeration date
09/23/2022
Last updated
01/09/2026
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