Provider Demographics
NPI:1508517491
Name:PIESCHL, IDA RAE
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:RAE
Last Name:PIESCHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16732 STATE ROAD 10
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:IN
Mailing Address - Zip Code:46511-9772
Mailing Address - Country:US
Mailing Address - Phone:785-845-3753
Mailing Address - Fax:
Practice Address - Street 1:1300 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-1234
Practice Address - Country:US
Practice Address - Phone:574-842-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program