Healthcare Provider Details

I. General information

NPI: 1003978024
Provider Name (Legal Business Name): DIANE V PETZ M.S., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 E 3RD ST 201
WINONA MN
55987-3478
US

IV. Provider business mailing address

66 E 3RD ST 201
WINONA MN
55987-3478
US

V. Phone/Fax

Practice location:
  • Phone: 507-452-7292
  • Fax: 507-457-9887
Mailing address:
  • Phone: 507-452-7292
  • Fax: 507-457-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3132
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: