Individual
ELIZABETH SOPHIA DEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4123 DUTCHMANS LN STE 606, LOUISVILLE, KY 40207-4725
(502) 896-2500
(502) 896-2527
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3015081
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3015081
KENTUCKY BOARD OF NURSING
KY
01
—
71010480A
INDIANA BOARD OF NURSING
IN
Enumeration date
09/16/2020
Last updated
01/31/2024
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