Healthcare Provider Details

I. General information

NPI: 1548288335
Provider Name (Legal Business Name): MARGARET ROSEANN DIEHL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARGARET ROSEANN CANNON CRNA

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY N #116
FARGO ND
58102-4421
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-6259
  • Fax: 701-234-7334
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR33874
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number544559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: