Individual
AUDREY DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
472 S STATE AVE, TAHLEQUAH, OK 74464-4326
(918) 330-0671
Mailing address
472 S STATE AVE, TAHLEQUAH, OK 74464-4326
(918) 330-0671
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/29/2021
Last updated
04/29/2021
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