Provider Demographics
NPI:1942618764
Name:DIETSCH, JULIET LAVELY (CPM)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:LAVELY
Last Name:DIETSCH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 BUTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6509
Mailing Address - Country:US
Mailing Address - Phone:502-439-3994
Mailing Address - Fax:502-327-7266
Practice Address - Street 1:1611 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1209
Practice Address - Country:US
Practice Address - Phone:502-439-3994
Practice Address - Fax:502-327-7266
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife