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General NPI Number Information
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NPI Number | 1235166737
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Entity Type | Individual
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Provider Name | DEANNA JO DIEBOLD M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N STE 401
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2986
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Country | US
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Telephone | 635-202-9407
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Fax | 763-520-2943
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Provider Business Mailing Address
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Address Line | 3366 OAKDALE AVE N STE 401
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2986
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Country | US
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Telephone | 763-520-2940
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Fax | 763-520-2943
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 37330
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 37330
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 37330
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License Number State | MN
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