Provider Demographics
NPI:1235015884
Name:DIERKS, ELLA PAULINE
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:PAULINE
Last Name:DIERKS
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 1:190 STAMFORD HTS
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-5631
Mailing Address - Country:US
Mailing Address - Phone:425-686-0099
Mailing Address - Fax:
Practice Address - Street 1:201 OLD MAIN
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-1503
Practice Address - Country:US
Practice Address - Phone:425-686-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program