Individual
MS. MARIE HELEN DIETRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
201 S GAMMON RD, MADISON, WI 53717-1404
(608) 663-6071
(608) 442-2196
Mailing address
201 S GAMMON RD, MADISON, WI 53717-1404
(608) 663-6071
(608) 442-2196
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
10192030
WI
363LP0200X
Pediatric Nurse Practitioner
3652033
WI
Other
Enumeration date
02/03/2012
Last updated
02/03/2012
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