Provider Demographics
NPI:1568052058
Name:DIMMEL, DARRIAN LEI
Entity Type:Individual
Prefix:
First Name:DARRIAN
Middle Name:LEI
Last Name:DIMMEL
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 1:507 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LE SUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-1534
Mailing Address - Country:US
Mailing Address - Phone:612-644-4510
Mailing Address - Fax:
Practice Address - Street 1:507 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-1534
Practice Address - Country:US
Practice Address - Phone:612-644-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer