Provider Demographics
NPI:1316528532
Name:DIECKHAUS, MARY FRANCES SKAPEK
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES SKAPEK
Last Name:DIECKHAUS
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 1:272 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4368
Mailing Address - Country:US
Mailing Address - Phone:708-752-2716
Mailing Address - Fax:
Practice Address - Street 1:406 BABBIDGE RD UNIT 1020
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1020
Practice Address - Country:US
Practice Address - Phone:708-752-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program