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JILL MAUREEN DIEDRING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1730
(260) 266-5700
(260) 266-5920
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28080833A
IN
363LF0000X
Family Nurse Practitioner
Primary
28080833A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000641072
ANTHEM
IN
01
P00826227
R.R. MEDICARE
IN
Enumeration date
02/19/2009
Last updated
10/20/2022
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