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Individual

MISS SARA GREENE DIEBOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
47488
KY
208000000X
Pediatrics Physician
Primary
ME169340
FL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000897766
ANTHEM
KY
01
50077879
PASSPORT HEALTH PLAN
KY
05
7100315080
KY
01
K360020
KY MEDICARE
KY
Enumeration date
03/31/2011
Last updated
07/30/2025
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