Provider Demographics
NPI:1144527698
Name:DIEHL, JAMIE MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MARIE
Last Name:DIEHL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-0580
Mailing Address - Country:US
Mailing Address - Phone:518-569-0912
Mailing Address - Fax:
Practice Address - Street 1:895 NYS ROUTE 9N
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-3207
Practice Address - Country:US
Practice Address - Phone:518-569-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304861-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse