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General NPI Number Information
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NPI Number | 1558801936
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Entity Type | Individual
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Provider Name | REBECCA LEE DIAZ NP
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Gender | Female
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Dates
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Enumeration Date | 03/03/2017
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1005 E. MAIN ST.
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City | CAMBRIDGE CITY
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State | IN
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Zip | 47327
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Country | US
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Telephone | 765-334-8365
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Fax | 414-622-3880
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Provider Business Mailing Address
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Address Line | N64W23110 MAIN ST.
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City | SUSSEX
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State | WI
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Zip | 53089-3230
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Country | US
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Telephone | 414-566-8400
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Fax | 414-622-3880
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007054A
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License Number State | IN
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