Provider Demographics
NPI:1558801936
Name:DIAZ, REBECCA LEE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEE
Other - Last Name:STRUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:N64W23110 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3230
Mailing Address - Country:US
Mailing Address - Phone:414-566-8400
Mailing Address - Fax:414-622-3880
Practice Address - Street 1:1005 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327
Practice Address - Country:US
Practice Address - Phone:765-334-8365
Practice Address - Fax:414-622-3880
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007054A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily