Provider Demographics
NPI:1568582294
Name:DIEHL, REBECCA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:DIEHL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:FOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:119 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-8812
Mailing Address - Country:US
Mailing Address - Phone:814-886-6833
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-942-1903
Practice Address - Fax:814-505-1100
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN514891L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101946688 0001Medicaid