Provider Demographics
NPI:1508998600
Name:DIEKMANN, JENNIFER LYNN (BSN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DIEKMANN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:FORRESTER-THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:600 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1499
Mailing Address - Country:US
Mailing Address - Phone:620-767-6811
Mailing Address - Fax:620-767-5611
Practice Address - Street 1:604 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1422
Practice Address - Country:US
Practice Address - Phone:620-767-5126
Practice Address - Fax:620-767-6910
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1493418051163WC0200X
KS93418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine