Individual
ETHAN J DIESTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1000
(636) 386-7810
Mailing address
PO BOX 22407, SAINT LOUIS, MO 63126-0407
(636) 386-7222
(636) 386-7810
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/10/2026
Last updated
03/10/2026
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