Individual
ELIZABETH ANN DIECKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
5230 E STOP 11 RD STE 300, INDIANAPOLIS, IN 46237-6401
(317) 961-5173
(317) 961-5183
Mailing address
PO BOX 39314, INDIANAPOLIS, IN 46239-0314
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28159275A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71074368A
IN
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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