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General NPI Number Information
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NPI Number | 1295376416
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Entity Type | Individual
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Provider Name | JEANNA LEE DIETZ NP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 5340 S QUEBEC ST STE 225N
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-1934
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Country | US
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Telephone | 720-734-4411
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Fax | 720-204-7497
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Provider Business Mailing Address
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Address Line | 5340 S QUEBEC ST STE 225N
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-1934
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Country | US
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Telephone | 720-734-4411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0995067-NP
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License Number State | CO
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