Provider Demographics
NPI:1780629311
Name:DIEGEL, TANYA L (DO)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:DIEGEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:701-253-5402
Practice Address - Street 1:132 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3056
Practice Address - Country:US
Practice Address - Phone:701-845-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0123522OtherMEDICA #
ND11198Medicaid
ND137116OtherUCARE #
ND412620300Medicaid
ND26072OtherNDBS #
ND46520OtherLHS #
ND323S2DIOtherMNBS #
ND990549OtherAMERICA'S PPO/ARAZ #
ND323S3DIOtherMNBS #
NDDA9061017665OtherPREFERRED ONE #
ND0123521OtherMEDICA #
ND26071OtherNDBS #
NDHP30667OtherHEALTHPARTNERS #
ND1014638OtherMEDICA #
ND323S4DIOtherMNBS #
NDDA9061017665OtherPREFERRED ONE #
ND26071OtherNDBS #
ND323S2DIOtherMNBS #