| NPI | 1528815057 |
|---|---|
| Former Name | MARCIA KATHERINE DIETZMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 464330) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-03 |