Individual
TERA NICOLE DIEWOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6000 UNIVERSITY AVE, STE 101, WEST DES MOINES, IA 50266-8203
(515) 241-2600
(515) 241-2032
Mailing address
PO BOX 1455, DES MOINES, IA 50306-1455
(515) 961-8448
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002114
IA
363A00000X
Physician Assistant
10492
MN
Other
Enumeration date
10/06/2008
Last updated
03/22/2016
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