Individual
DIANE K. FITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1021 NEBRASKA ST, SIOUX CITY, IA 51105-1436
(712) 252-2477
(712) 252-5920
Mailing address
1021 NEBRASKA ST, SIOUX CITY, IA 51105-1436
(712) 252-2477
(712) 252-5920
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000656
IA
363AM0700X
Medical Physician Assistant
511
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53002
WELLMARK BCBS OF IOWA
—
05
—
6828970
—
SD
01
—
IB1201002
MEDICARE PTAN
IA
01
—
P00353384
MEDICARE RAILROAD
—
Enumeration date
04/19/2006
Last updated
08/26/2014
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