Individual
SAMANTHA DIETMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4801 VETERANS DR, SAINT CLOUD, MN 56303-2015
(320) 252-1670
Mailing address
2517 OCARINA DR, SAUK RAPIDS, MN 56379-4608
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L72612-2
MN
Other
Enumeration date
01/09/2025
Last updated
01/09/2025
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