Provider Demographics
NPI:1982793725
Name:DIEHL, AMANDA N (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:N
Last Name:DIEHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:NICHOLE
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 PINE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1669
Mailing Address - Country:US
Mailing Address - Phone:605-721-8939
Mailing Address - Fax:
Practice Address - Street 1:350 PINE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1669
Practice Address - Country:US
Practice Address - Phone:605-721-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4739208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4993484OtherWELLMARK
SD6700463Medicaid
SD6700462Medicaid
SD9213203OtherDAKOTACARE
SD6700463Medicaid
H19908Medicare UPIN
SDS41204Medicare ID - Type Unspecified