Provider Demographics
NPI:1821826322
Name:DIECKMANN, VICTORIA PATRICIA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:PATRICIA
Last Name:DIECKMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:231 HAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2611
Mailing Address - Country:US
Mailing Address - Phone:724-355-9481
Mailing Address - Fax:
Practice Address - Street 1:3550 TERRACE STREET
Practice Address - Street 2:613 SCAIFE HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-946-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA065753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant