Provider Demographics
NPI:1871724161
Name:DIEHN, TONYA NORVELL (PA)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:NORVELL
Last Name:DIEHN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 EAST 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317
Mailing Address - Country:US
Mailing Address - Phone:515-248-1600
Mailing Address - Fax:515-248-1610
Practice Address - Street 1:3509 E 29TH STREET
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317
Practice Address - Country:US
Practice Address - Phone:515-248-1600
Practice Address - Fax:515-248-1610
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant