Individual
JACQUELINE ANDRIA DIETRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
809 MAIN ST, EAST HARTFORD, CT 06108-3117
(860) 528-1359
Mailing address
809 MAIN ST, EAST HARTFORD, CT 06108-3117
(860) 528-1359
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
8199
CT
Other
Enumeration date
09/08/2019
Last updated
09/08/2019
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