Healthcare Provider Details

I. General information

NPI: 1942618764
Provider Name (Legal Business Name): JULIET LAVELY DIETSCH CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 BARDSTOWN RD
LOUISVILLE KY
40205-1209
US

IV. Provider business mailing address

1913 BUTTONWOOD RD
LOUISVILLE KY
40222-6509
US

V. Phone/Fax

Practice location:
  • Phone: 502-439-3994
  • Fax: 502-327-7266
Mailing address:
  • Phone: 502-439-3994
  • Fax: 502-327-7266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: