Jillian Victoria Dietz, APN -CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209009223 Issued in IN

Practice address

9008 Indianapolis Blvd
Highland, IN 46322-2501

Phone

(219) 513-8923

Fax

(219) 513-8941

NPI assigned

Nov 16, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Jillian Victoria Lessard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aesquivel Professional Corporation

  • Home Health Agency
  • Highland, IN
  • NPI 1891747986
  NPD (past)
• Layous LLC

  • Medical Specialty Clinic/Center
  • Munster, IN
  • NPI 1598144040
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1316214554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3063",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463210063",
            "telephone_number": "219-513-8923",
            "fax_number": "219-513-8941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9008 INDIANAPOLIS BLVD",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463222501",
            "telephone_number": "219-513-8923",
            "fax_number": "219-513-8941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3156 Willowcreek Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463684424",
            "country_code": "US",
            "telephone_number": "219-513-8923",
            "fax_number": "219-513-8941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "JILLIAN",
        "middle_name": "VICTORIA",
        "name_prefix": "Mrs.",
        "credential": "APN -CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-16",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.009223",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "209009223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300000084",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "LESSARD",
            "middle_name": "VICTORIA",
            "prefix": "MISS",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Desiree Davis
• Christelle Deery
• Heidi M Dennies, HOME HEALTH CARE
• Dessie Kammer LLC
• Destiny Home Healthcare Inc
• Joyce Dittmann
• Divine Intervention Healthcare, Inc
• Doctor'S Pharmacy
• Dollarvisionclub Corp.
• Tye Dominguez, LCAC, LMHC, NCC

• Family Nurse Practitioner in Highland, IN
• Providers in Highland, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.