Provider Demographics
NPI:1699951590
Name:DIEDRICH, RETA JOYCE (RN)
Entity type:Individual
Prefix:MRS
First Name:RETA
Middle Name:JOYCE
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 POWER AVE S
Mailing Address - Street 2:P.O. BOX 684
Mailing Address - City:HINCKLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55037-9366
Mailing Address - Country:US
Mailing Address - Phone:320-384-6039
Mailing Address - Fax:
Practice Address - Street 1:119 4TH ST.
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072
Practice Address - Country:US
Practice Address - Phone:320-245-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR059996-4163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management