| NPI | 1073144457 |
|---|---|
| Former Name | HEATHER DIETIKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71013707A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO F01200117) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 27788) | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2023-10-02 |