MEDICARE: AMY SCHMOLL DIERSING FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	28154981A	IN

General Provider Information

NPI Number	:	1316370638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SCHMOLL DIERSING FNP

Provider Business Mailing Address
First Line	:	4435 TARRAGON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3671
Country	:	US
Telephone Number	:	317-340-3092
Fax Number	:

Provider Business Practice Location Address
First Line	:	7375 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-8950
Country	:	US
Telephone Number	:	317-861-4171
Fax Number	:	317-861-5325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2013
Last Update Date	:	08/11/2013

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