Provider Demographics
NPI:1922661537
Name:DIEMER, ANN MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:DIEMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 S DENALI ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8117
Mailing Address - Country:US
Mailing Address - Phone:907-707-9621
Mailing Address - Fax:
Practice Address - Street 1:590 S DENALI ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8117
Practice Address - Country:US
Practice Address - Phone:907-707-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK141805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty