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Individual
ELIZABETH JEAN DIETRICH
Active
Individual
ELIZABETH JEAN DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01118
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200540762RN
OR STATE BOARD OF NURSING
OR
05
—
500632421
—
OR
01
—
PA01118
OBME LICENSE
OR
Enumeration date
12/07/2006
Last updated
11/29/2012
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