Provider Demographics
NPI:1962872119
Name:DIEGELMANN, JULIE ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:DIEGELMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ELIZABETH
Other - Last Name:SPEHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2205 CROCKER RD STE 109
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6710
Mailing Address - Country:US
Mailing Address - Phone:440-249-0274
Mailing Address - Fax:440-808-1718
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:BUILDING 1, SUITE 501
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-482-8424
Practice Address - Fax:440-808-1718
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005111RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant