MEDICARE: MS. HELEN MARIE DIETRICK R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	R052441	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R052441	OTHER	MD	REGISTERED NURSE LICENSE

General Provider Information

NPI Number	:	1356348023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELEN MARIE DIETRICK R.N.

Provider Business Mailing Address
First Line	:	9089 LAMBSKIN LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2940
Country	:	US
Telephone Number	:	410-992-1839
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 SECURITY BLVD
Second Line	:	N3-22-07
City	:	BALTIMORE
State	:	MD
Zip	:	21244-1849
Country	:	US
Telephone Number	:	410-786-7448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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