Provider Demographics
NPI:1184873895
Name:DIETERICH, CHRISTI ANN (NP)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:ANN
Last Name:DIETERICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:ANN
Other - Last Name:MOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2783 AUTUMN CHASE RUN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7259
Mailing Address - Country:US
Mailing Address - Phone:443-414-6411
Mailing Address - Fax:
Practice Address - Street 1:6095 MARSHALEE DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6053
Practice Address - Country:US
Practice Address - Phone:410-279-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR146251363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology