Individual
AMANDA DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3101 BROADWAY BLVD, KANSAS CITY, MO 64111-2659
(816) 960-3050
(816) 960-3038
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
77165
KS
363LF0000X
Family Nurse Practitioner
Primary
2016005845
MO
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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