Provider Demographics
NPI:1215626361
Name:DIETZMAN, KASEY LYNNE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:LYNNE
Last Name:DIETZMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BRISAN WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2733
Mailing Address - Country:US
Mailing Address - Phone:774-454-7748
Mailing Address - Fax:
Practice Address - Street 1:907 SUMNER ST STE M-102
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3374
Practice Address - Country:US
Practice Address - Phone:781-344-3791
Practice Address - Fax:781-341-3614
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2023004608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily