Provider Demographics
NPI:1124515861
Name:DIEHL, CELIA M (LPN, NO 307099-031)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:M
Last Name:DIEHL
Suffix:
Gender:F
Credentials:LPN, NO 307099-031
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:M
Other - Last Name:HUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1002 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1133
Mailing Address - Country:US
Mailing Address - Phone:920-986-1586
Mailing Address - Fax:
Practice Address - Street 1:2124 ORRIE LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4345
Practice Address - Country:US
Practice Address - Phone:920-530-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307099-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse