Provider Demographics
NPI:1548288335
Name:DIEHL, MARGARET ROSEANN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ROSEANN
Last Name:DIEHL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ROSEANN
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:737 BROADWAY N
Practice Address - Street 2:#116
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4421
Practice Address - Country:US
Practice Address - Phone:701-234-6259
Practice Address - Fax:701-234-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33874367500000X
TX544559367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24887Medicare PIN
TX82059HMedicare PIN
TX430053116Medicare PIN