Individual
BRIAN RUSSELL DIEDRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
23 S CHAMISA DR, SANTA FE, NM 87508-9149
(303) 506-7260
Mailing address
23 S CHAMISA DR, SANTA FE, NM 87508-9149
(303) 506-7260
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
62824
NM
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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