Healthcare Provider Details

I. General information

NPI: 1194823351
Provider Name (Legal Business Name): DIANA LYNN DIPPEL RNCPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MULBERRY ST
EVANSVILLE IN
47713-1231
US

IV. Provider business mailing address

1429 MESKER PARK DR
EVANSVILLE IN
47720-8223
US

V. Phone/Fax

Practice location:
  • Phone: 812-435-2431
  • Fax: 812-435-5011
Mailing address:
  • Phone: 812-423-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number7100003A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: