MEDICARE: DR. HANNAH ELIZABETH DIETZ DACM, LAC

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	171100000X	Acupuncturist	2064	NC

General Provider Information

NPI Number	:	1962252940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANNAH ELIZABETH DIETZ DACM, LAC

Provider Business Mailing Address
First Line	:	19 SOUTH ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-3963
Country	:	US
Telephone Number	:	207-358-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 SOUTH ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-3963
Country	:	US
Telephone Number	:	207-358-3615
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	07/01/2025

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