Individual
PAM DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
13050 PARKSIDE DR, 150, FISHERS, IN 46038-8247
(317) 621-9000
(317) 621-9194
Mailing address
13050 PARKSIDE DR, 150, FISHERS, IN 46038-8247
(317) 621-9000
(317) 621-9194
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
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