Provider Demographics
NPI:1427167600
Name:JOLLES, DIANA RACHEL (CNM)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:RACHEL
Last Name:JOLLES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:RACHEL
Other - Last Name:CAPLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5819 N FM 88
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-969-2538
Mailing Address - Fax:956-969-5884
Practice Address - Street 1:5819 N FM 88
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-969-2538
Practice Address - Fax:956-969-5884
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1008299367A00000X
TX673674367A00000X
NJ25ME00083700367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC038622700Medicaid
DC038622700Medicaid