Provider Demographics
NPI:1083347694
Name:DIEP, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DIEP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5251 BISHOPS BAY PKWY APT 114
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53597-8843
Mailing Address - Country:US
Mailing Address - Phone:818-849-0037
Mailing Address - Fax:
Practice Address - Street 1:5251 BISHOPS BAY PKWY APT 114
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53597-8843
Practice Address - Country:US
Practice Address - Phone:818-849-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program