Provider Demographics
NPI:1376821090
Name:DIEHN, BETHANY J (LPN)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:J
Last Name:DIEHN
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 1:21092 451ST AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55307-9431
Mailing Address - Country:US
Mailing Address - Phone:507-964-5334
Mailing Address - Fax:
Practice Address - Street 1:21092 451ST AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MN
Practice Address - Zip Code:55307-9431
Practice Address - Country:US
Practice Address - Phone:507-964-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 071641-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse