Healthcare Provider Details

I. General information

NPI: 1952185928
Provider Name (Legal Business Name): TINA DIEPENBROCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

2253 NEPTUNE PL SW
ROCHESTER MN
55902-5002
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-3373
  • Fax:
Mailing address:
  • Phone: 612-961-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR162811-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: