Individual
MR. DAVID ALAN DIETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
184 LIBERTY ST, NEW HAVEN, CT 06519-1625
(203) 688-9791
Mailing address
1304 WEST ST, GUILFORD, CT 06437-1075
(034) 571-9662
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
004178
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008058287
—
CT
Enumeration date
03/26/2015
Last updated
09/30/2019
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