Individual
JACALYN MARIE DIEZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
200 EAST STATE STREET, ALLIANCE, OH 44601
(330) 596-7227
(330) 596-7214
Mailing address
200 EAST STATE STREET, ALLIANCE, OH 44601
(330) 596-7227
(330) 596-7214
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
NA-00324
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000232285
ANTHEM
—
05
—
0847285
—
OH
01
—
430077988
MEDICARE RAILROAD
—
Enumeration date
10/12/2006
Last updated
06/13/2016
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