Provider Demographics
NPI:1821627720
Name:DIETRICH, ROSE ANNA (NP)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:ANNA
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 METRO PL S # 1001
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-5316
Mailing Address - Country:US
Mailing Address - Phone:877-724-4748
Mailing Address - Fax:
Practice Address - Street 1:545 METRO PL S # 1001
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5316
Practice Address - Country:US
Practice Address - Phone:877-724-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014635363L00000X
OHAPRN.CNP.0028234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty