Provider Demographics
NPI:1386414431
Name:DIETERMAN KLINIK, LLC
Entity type:Organization
Organization Name:DIETERMAN KLINIK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ABIGAIL
Authorized Official - Last Name:DIETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, BSN
Authorized Official - Phone:816-695-2433
Mailing Address - Street 1:4200 SOMERSET DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6208 FALL HARVEST WAY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-7242
Practice Address - Country:US
Practice Address - Phone:816-695-2433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care