Healthcare Provider Details

I. General information

NPI: 1316655335
Provider Name (Legal Business Name): MAUREEN DIETRICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY FL 5
DOVER NH
03820-5933
US

IV. Provider business mailing address

70 GOODWIN ST
SOUTH BERWICK ME
03908-1120
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNH
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number090171-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: