Individual
DIANE DIECKMAN JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
600 N PICKAWAY ST, CIRCLEVILLE, OH 43113-2409
(740) 474-2126
(740) 477-1022
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34003715M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316758
BCBS
OH
05
—
0937053
—
OH
01
—
P00093121
RR MEDICARE
OH
Enumeration date
05/01/2006
Last updated
08/06/2013
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