Provider Demographics
NPI:1316120215
Name:DIEBOLD, ERIN A (MSN, FNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:A
Last Name:DIEBOLD
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:# 112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-9836
Mailing Address - Fax:317-988-5328
Practice Address - Street 1:6845 E US HIGHWAY 36
Practice Address - Street 2:SUITE 600
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9779
Practice Address - Country:US
Practice Address - Phone:317-272-4920
Practice Address - Fax:317-273-1409
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily