Provider Demographics
NPI:1811966864
Name:DEIGMANN, DIANE LOUISE (CRNA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:DEIGMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:DEIGMANN
Other - Last Name:BUNGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 EAGAN WOODS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1138
Mailing Address - Country:US
Mailing Address - Phone:651-968-5240
Mailing Address - Fax:
Practice Address - Street 1:2620 EAGAN WOODS DR STE 300
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1138
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 122795-0367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN954662600Medicaid
MN959695000Medicaid
MN479L7CHOtherBLUE CROSS OF MN
MN954662600Medicaid