Doctor Name: | CHRISTI ANN DIETERICH |
NPI Number: | 1184873895 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R146251 |
Business Practice Address: | 6095 Marshalee Dr Elkridge, MD - 210756053 |
Business Phone Number: | 4102793284 |
Business Fax Number: | |
Mailing Address: | 2783 Autumn Chase Run, ANNAPOLIS |
State: | MD |
Postal Code: | 214017259 |
Phone Number: | 4434146411 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2008 |
NPI Last Update Date: | 10/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | R146251 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |