Provider Demographics
NPI:1871802686
Name:DIEVENDORF, AMY JEANETTE (APRN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JEANETTE
Last Name:DIEVENDORF
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:SUITE - 425
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7878
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:1655 BERNARDIN AVENUE
Practice Address - Street 2:SUITE - 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-253-7575
Practice Address - Fax:803-253-7571
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2017-01-19
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Provider Licenses
StateLicense IDTaxonomies
SC4341SC363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC7793F560Medicare PIN