Provider Demographics
NPI:1558352617
Name:DIEGO, NENITA S (MD)
Entity Type:Individual
Prefix:
First Name:NENITA
Middle Name:S
Last Name:DIEGO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:57950 LEAVENWORTH ST
Mailing Address - Street 2:22D MEDICAL GROUP
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3506
Mailing Address - Country:US
Mailing Address - Phone:316-759-5864
Mailing Address - Fax:316-759-5038
Practice Address - Street 1:57950 LEAVENWORTH ST
Practice Address - Street 2:22D MEDICAL GROUP
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3506
Practice Address - Country:US
Practice Address - Phone:316-759-5864
Practice Address - Fax:316-759-5038
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
KS17124208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine