Provider Demographics
NPI:1013305200
Name:DIEHN, KRISTINA L
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:DIEHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:L
Other - Last Name:HERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 S LAKE DR LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3171
Mailing Address - Country:US
Mailing Address - Phone:414-744-4000
Mailing Address - Fax:414-489-4022
Practice Address - Street 1:9969 S 27TH ST FL 2
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9533
Practice Address - Country:US
Practice Address - Phone:414-325-4950
Practice Address - Fax:414-325-6372
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6175363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology