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General NPI Number Information
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NPI Number | 1689744542
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Entity Type | Individual
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Provider Name | MARCIA BECKER DIETZ MS RN CS
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2613 W HENRIETTA RD
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City | ROCHESTER
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State | NY
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Zip | 14623-2327
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Country | US
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Telephone | 585-279-4913
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Fax | 585-461-9504
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Provider Business Mailing Address
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Address Line | 122 BUCKLEY PLACE
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City | HENRIETTA
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State | NY
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Zip | 14467-9341
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Country | US
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Telephone | 585-334-8823
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 284509-1
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License Number State | NY
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