Provider Demographics
NPI:1356858476
Name:DIERDORFF, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:DIERDORFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:XUEQING
Other - Middle Name:
Other - Last Name:DIERDORFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17405-2347
Mailing Address - Country:US
Mailing Address - Phone:717-851-1543
Mailing Address - Fax:717-798-3250
Practice Address - Street 1:2350 FREEDOM WAY STE 202
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8202
Practice Address - Country:US
Practice Address - Phone:717-851-1543
Practice Address - Fax:717-798-3250
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018308363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care