Individual
MRS. DIANE M. LIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP-C
Contact information
Practice address
800 W STATE ST, JACKSONVILLE, IL 62650-2290
(217) 243-2292
(217) 243-5359
Mailing address
862 WORRELL LN, WINCHESTER, IL 62694-3628
(217) 371-2901
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209010294
IL
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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