Dietrich, Mark B

Dietrich, Mark B is an individual health care provider with primary practice located at 384 Roark Ln , Mc Donald TN 37353-5238. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Dietrich, Mark B can be contacted via phone (423) 503-6343.

Contact Information

Primary practice address
384 Roark Ln Mc Donald TN 37353-5238
Phone: (423) 503-6343
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X APN12260 Tennessee

Profile Details

NPI number 1427127190
LBN Legal business name Dietrich, Mark B
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2006
Last updated Jan 24th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427127190 NPPES
Alabama MEDICAID 104592
Alabama Other P00744539
Alabama MEDICAID 1509502
Alabama Other N457415
Alabama MEDICAID 002470891B
Alabama Other 4185343
Alabama MEDICAID 8053520

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