Provider Demographics
NPI:1609183862
Name:BIELEFELD, DIANE L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:BIELEFELD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-566-6338
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY STE 305
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1891
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-566-6338
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28183928A363LF0000X
KY1056968363LF0000X
KY3006317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300008568Medicaid
KY7100224490Medicaid