Provider Demographics
NPI:1619972353
Name:DIEHL, LOUISE M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:M
Last Name:DIEHL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1900
Mailing Address - Country:US
Mailing Address - Phone:908-213-8808
Mailing Address - Fax:908-213-8898
Practice Address - Street 1:101 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1900
Practice Address - Country:US
Practice Address - Phone:908-213-8808
Practice Address - Fax:908-213-8898
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008237363LA2200X
NJ26NJ00018700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8978000Medicaid
NJ8978000Medicaid
NJP65497Medicare UPIN