Individual
CONNIE I DIERCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
555 CEDAR ST, SAINT PAUL, MN 55101-2209
(651) 266-1255
(651) 266-1350
Mailing address
3821 E 26TH ST, MINNEAPOLIS, MN 55406-1857
(612) 729-3059
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
CNM0216
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339540500
—
MN
Enumeration date
03/29/2006
Last updated
03/27/2015
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