Individual
KARLA KAY DIERLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
1014 S RANDOLPH ST, GARRETT, IN 46738-1913
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28126019A
IN
Other
Enumeration date
10/28/2008
Last updated
10/28/2008
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