Healthcare Provider Details

I. General information

NPI: 1356348023
Provider Name (Legal Business Name): HELEN MARIE DIETRICK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SECURITY BLVD N3-22-07
BALTIMORE MD
21244-1849
US

IV. Provider business mailing address

9089 LAMBSKIN LN
COLUMBIA MD
21045-2940
US

V. Phone/Fax

Practice location:
  • Phone: 410-786-7448
  • Fax:
Mailing address:
  • Phone: 410-992-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR052441
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: