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1407231244
ROBERT DIDERICKSEN
EUGENE, OR
NPI
1407231244
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CO 0995173)
Enumeration Date
2015-07-22
Last Update Date
2021-11-04
Business Address
ROBERT DIDERICKSEN PMHNP-BC
1501 PEARL ST
EUGENE, OR 97401-4010
Phone number: 541-342-8437
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Mailing Address
ROBERT DIDERICKSEN PMHNP-BC
1258 HIGH ST
EUGENE, OR 97401-3238
Phone number: 541-342-8437
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