Individual
MRS. CHRISTINE MARIE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, GNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2004-33
WI
363LG0600X
Gerontology Nurse Practitioner
R200410-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004881926
MEDICARE PIN
WI
05
—
1376747261
—
MN
05
—
1376747261
—
WI
Enumeration date
06/13/2007
Last updated
08/14/2019
Update your record
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