Individual
MRS. JILLIAN VICTORIA DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN -CNP
Contact information
Practice address
9008 INDIANAPOLIS BLVD, HIGHLAND, IN 46322-2501
(219) 513-8923
(219) 513-8941
Mailing address
PO BOX 3063, MUNSTER, IN 46321-0063
(219) 513-8923
(219) 513-8941
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.009223
IL
363LF0000X
Family Nurse Practitioner
Primary
209009223
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300000084
—
IN
Enumeration date
11/16/2011
Last updated
12/21/2018
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