Provider Demographics
NPI:1245962232
Name:DIETER, MARISA KALIE (ARNP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:KALIE
Last Name:DIETER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:K
Other - Last Name:ARNESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:759 E HOLLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-270-0065
Mailing Address - Fax:509-319-2520
Practice Address - Street 1:759 E HOLLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-866-0200
Practice Address - Fax:509-866-0057
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61328491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245962232OtherNPPES