Organization
MICHELLE DIEDRICHSEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE LAUREN DIEDRICHSEN (BST)
(775) 426-9319
Entity
Organization
Contact information
Practice address
295 E PARK ST, FALLON, NV 89406-3417
(775) 426-9319
Mailing address
295 E PARK ST, FALLON, NV 89406-3417
(775) 426-9319
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530557121
—
NV
Enumeration date
03/05/2015
Last updated
03/05/2015
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