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BLACK DIAMOND MEDICAL LLC
NPI 1639644909
Nurse Practitioner - Primary Care in Peoria, AZ

Active since October 12, 2018
20449 N LAKE PLEASANT RD STE 101, PEORIA, AZ 85382(623) 322-0099 Get Directions Write a Review

NPPES record last updated: March 6, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 6, 2020, Oct 12, 2018 (2 updates tracked since 2018).

About Black Diamond Medical Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACK DIAMOND MEDICAL LLC (NPI 1639644909) is a healthcare organization registered as a primary care in Peoria, Arizona and active in the NPI registry since October 2018. The organization lists Tonia Lanette Graham, Co-owner, as its authorized official.

NPPES Registry Identity

NPI1639644909
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameBLACK DIAMOND MEDICAL LLC
Location Address20449 N LAKE PLEASANT RD STE 101Peoria, AZ 85382-2707
Mailing Address20449 N Lake Pleasant Rd Ste 101Peoria, AZ 85382-2707 · (623) 322-0099
Phone(623) 322-0099
Organization SubpartNo
Authorized OfficialTonia Lanette GrahamCo-owner · (623) 322-0099
Enumeration DateOctober 12, 2018
Last NPPES UpdateMarch 6, 20202 updates tracked since enumeration
NPPES CertifiedMarch 6, 2020
✔ NPI 1639644909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedClinic/Center · Urgent CareTaxonomy 261QU0200X
20449 N LAKE PLEASANT RD STE 101, Peoria, AZ 85382
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WELLNESS FOR LIFE FAMILY PRACTICE
Nurse Practitioner (Primary Care)
20449 N LAKE PLEASANT RD STE 101
PEORIA, AZ 85382
Maricopa County (623) 322-0099
MRS. MELODY DAWN AUSTIN FNP
Nurse Practitioner (Family)
20449 N LAKE PLEASANT RD STE 101
PEORIA, AZ 85382
Maricopa County (623) 322-0099
HONEY HEALTH LLC
Nurse Practitioner (Primary Care)
20449 N LAKE PLEASANT RD STE 101
PEORIA, AZ 85382
Maricopa County (623) 322-0099
TONIA LANETTE GRAHAM FNP
Nurse Practitioner (Primary Care)
20449 N LAKE PLEASANT RD STE 101
PEORIA, AZ 85382
Maricopa County (602) 570-5587

Frequently Asked Questions

What is BLACK DIAMOND MEDICAL LLC's NPI number?

The NPI number assigned to this healthcare provider is 1639644909, enumerated as an "organization" on October 12, 2018.

Where is the provider located?

The provider is located at 20449 N LAKE PLEASANT RD STE 101 PEORIA, AZ 85382 and the phone number is (623) 322-0099.

What is the provider's specialty?

Nurse Practitioner with taxonomy code 363LP2300X and a focus in Primary Care.