Individual
TERESA G. DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
301 E JACKSON ST, DILLON, SC 29536-2509
(843) 774-1166
(843) 777-5035
Mailing address
PO BOX 100567, FLORENCE, SC 29501-0567
(843) 777-5813
(843) 777-5035
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R31431
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0504
—
SC
Enumeration date
04/03/2006
Last updated
07/09/2007
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