| NPI | 1194492140 |
|---|---|
| Former Name | ELIZABETH CLARA DIEDRICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 262994) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-08-26 |