Provider Demographics
NPI:1083350672
Name:DIETZENBACH, LEXI
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:
Last Name:DIETZENBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR STE 319
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5620
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:319-272-5788
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 319
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5620
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-5788
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA164613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily