Provider Demographics
NPI:1093229296
Name:DIEHM, SEAGAN KAY
Entity Type:Individual
Prefix:
First Name:SEAGAN
Middle Name:KAY
Last Name:DIEHM
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 1:1059 STATE ROAD 8
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:IN
Mailing Address - Zip Code:46738-9703
Mailing Address - Country:US
Mailing Address - Phone:260-246-7353
Mailing Address - Fax:
Practice Address - Street 1:413 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3201
Practice Address - Country:US
Practice Address - Phone:260-469-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF06172243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily