Provider Demographics
NPI:1124145131
Name:DIEHL, LISA MARIE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:DIEHL
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 1:1556 S FREEDOM AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4265
Mailing Address - Country:US
Mailing Address - Phone:330-224-6147
Mailing Address - Fax:
Practice Address - Street 1:350 S ARCH AVE
Practice Address - Street 2:APT. 501
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2606
Practice Address - Country:US
Practice Address - Phone:330-704-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2295841Medicaid