Healthcare Provider Details

I. General information

NPI: 1871935346
Provider Name (Legal Business Name): JERRY DIEHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GERALDINE HUGGINS

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 11/17/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S GOULD RD
COLUMBUS OH
43209-1931
US

IV. Provider business mailing address

308 S GOULD RD
COLUMBUS OH
43209-1931
US

V. Phone/Fax

Practice location:
  • Phone: 614-716-9018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number376832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: