Provider Demographics
NPI:1568072296
Name:BENNER, DIANE LOUISE (MSN, RN, IBCLC, RLC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LOUISE
Last Name:BENNER
Suffix:
Gender:F
Credentials:MSN, RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3241
Mailing Address - Country:US
Mailing Address - Phone:317-726-0668
Mailing Address - Fax:
Practice Address - Street 1:1925 TULIP LN
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3241
Practice Address - Country:US
Practice Address - Phone:317-726-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28104921163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28104921AOtherREGISTERED NURSE LICENSE
L-13475OtherINTERNATIONAL LACTATION CERTIFICATION ASSOCIATION
IL041409047OtherREGISTERED NURSE LICENSE