MEDICARE: JENNIFER DIETRICH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024172207	VA

General Provider Information

NPI Number	:	1821496720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DIETRICH FNP

Provider Business Mailing Address
First Line	:	28 ABBY RD
Second Line	:
City	:	PALMYRA
State	:	VA
Zip	:	22963-2085
Country	:	US
Telephone Number	:	434-589-2278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 SANTA ROSA RD RM 114
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23229-5109
Country	:	US
Telephone Number	:	804-210-3103
Fax Number	:	804-210-3104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	06/05/2024

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