Healthcare Provider Details

I. General information

NPI: 1619746948
Provider Name (Legal Business Name): KRYSTLE MARIE DRIETZ CNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WALNUT ST
DAWSON MN
56232-2333
US

IV. Provider business mailing address

1867 HIGHWAY 75
CANBY MN
56220-2038
US

V. Phone/Fax

Practice location:
  • Phone: 320-769-4323
  • Fax:
Mailing address:
  • Phone: 507-828-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11138
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: