Provider Demographics
NPI:1952028128
Name:DIEKMAN, DEBRA MAE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MAE
Last Name:DIEKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1951
Mailing Address - Country:US
Mailing Address - Phone:231-445-1017
Mailing Address - Fax:231-368-6440
Practice Address - Street 1:9210 N EXTENSION RD
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-8556
Practice Address - Country:US
Practice Address - Phone:231-445-1017
Practice Address - Fax:231-368-6440
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care