Healthcare Provider Details

I. General information

NPI: 1558801936
Provider Name (Legal Business Name): REBECCA LEE DIAZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LEE STRUNK NP

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 01/21/2025
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E. MAIN ST.
CAMBRIDGE CITY IN
47327
US

IV. Provider business mailing address

N64W23110 MAIN ST.
SUSSEX WI
53089-3230
US

V. Phone/Fax

Practice location:
  • Phone: 765-334-8365
  • Fax: 414-622-3880
Mailing address:
  • Phone: 414-566-8400
  • Fax: 414-622-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007054A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: