Provider Demographics
NPI:1194823351
Name:DIPPEL, DIANA LYNN (RNCPNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:DIPPEL
Suffix:
Gender:F
Credentials:RNCPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 MESKER PARK DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-8223
Mailing Address - Country:US
Mailing Address - Phone:812-423-7346
Mailing Address - Fax:
Practice Address - Street 1:420 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1231
Practice Address - Country:US
Practice Address - Phone:812-435-2431
Practice Address - Fax:812-435-5011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7100003A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS89598Medicare UPIN
INTB1460Medicare ID - Type Unspecified