Individual
PAM DIETZ
Active
Individual
PAM DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2811972A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
2811972A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351767385
TAX ID
IN
Enumeration date
06/15/2007
Last updated
02/24/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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