Individual
CAROL M. DIETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1441 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1707
(563) 383-1900
Mailing address
1441 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1707
(563) 383-1900
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
034112
IA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G034112
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420716337
—
IA
Enumeration date
02/06/2007
Last updated
05/22/2008
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