MARY THERESE DIERICH GNP NPI 1346345717

NPI Information

NPI: 1346345717
Provider Name: MARY THERESE DIERICH, GNP
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
516 DELAWARE ST SE
3-150 PWB, CLINIC 3A
MINNEAPOLIS, MN
ZIP 55455
Phone: (612) 624-9499
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Mary Therese Dierich, GNP is a gerontology nurse practitioner in Minneapolis, MN. Mary Therese Dierich, GNP NPI is 1346345717. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

516 DELAWARE ST SE
3-150 PWB, CLINIC 3A
MINNEAPOLIS, MN
ZIP 55455-356
Phone: (612) 624-9499

The NPI 1346345717 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/13/2006 and was last updated on 3/24/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LG0600X	Nurse Practitioner	Gerontology	R 094653-3	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	S45397	MEDICARE UPIN	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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