Individual
BARBARA LYNN DIERKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5700 PIASA TRL, GODFREY, IL 62035-1030
(618) 946-6126
Mailing address
5700 PIASA TRL, GODFREY, IL 62035-1030
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
2015032726
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015032726
RN LICENSE
MO
Enumeration date
03/06/2019
Last updated
06/11/2019
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