Provider Demographics
NPI:1477971083
Name:DIES, JOHN (NP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DIES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 TIVOLI ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5173
Mailing Address - Country:US
Mailing Address - Phone:337-893-0788
Mailing Address - Fax:337-893-0787
Practice Address - Street 1:121 TIVOLI ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5173
Practice Address - Country:US
Practice Address - Phone:337-893-0788
Practice Address - Fax:337-893-0787
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily