| NPI | 1245727445 |
|---|---|
| Former Name | MANDY L DIESTLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 13439) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 13439) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2023-01-09 |