Individual
MARY THERESE DIERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
516 DELAWARE ST SE, 3-150 PWB, CLINIC 3A, MINNEAPOLIS, MN 55455-0356
(612) 624-9499
Mailing address
420 DELAWARE ST SE, MMC 381, MINNEAPOLIS, MN 55455-0341
(612) 624-9499
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R 094653-3
MN
Other
Enumeration date
09/13/2006
Last updated
03/24/2009
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