Provider Demographics
NPI:1356167209
Name:DIETERICH, MEENA KUMARI (CPM)
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:KUMARI
Last Name:DIETERICH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NORTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2909
Mailing Address - Country:US
Mailing Address - Phone:917-912-0516
Mailing Address - Fax:
Practice Address - Street 1:105 NORTH AVE APT 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-2909
Practice Address - Country:US
Practice Address - Phone:917-912-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0129930176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife