Provider Demographics
NPI:1588190755
Name:DIEM, ERIN ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:DIEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 S STATE ROAD 129
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:IN
Mailing Address - Zip Code:47042-9114
Mailing Address - Country:US
Mailing Address - Phone:812-756-2965
Mailing Address - Fax:
Practice Address - Street 1:955 N MICHIGAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1487
Practice Address - Country:US
Practice Address - Phone:812-662-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1111959163W00000X
IN71007568A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1588190755Medicaid