Individual
ALISA MICHELLE DIETERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N. M.S.N. F.N.P.
Contact information
Practice address
11333 PROSPECT DRIVE, MARTELL, CA 95654
(209) 268-0560
(209) 214-6946
Mailing address
967 BIG SUR CT, EL DORADO HILLS, CA 95762-4508
(707) 486-2672
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP18158
CA
Other
Enumeration date
07/22/2008
Last updated
02/11/2022
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