Individual
CHRISTINE DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 2ND ST S, SARTELL, MN 56377-1977
(320) 251-2600
(320) 251-4763
Mailing address
100 2ND ST S, SARTELL, MN 56377-1977
(320) 251-2600
(320) 251-4763
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R128637-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376718300
—
MN
Enumeration date
04/05/2006
Last updated
01/31/2017
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