Brian Russell Diedrich, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

62824 Issued in NM

Practice address

23 S Chamisa Dr
Santa Fe, NM 87508-9149

Phone

(303) 506-7260

NPI assigned

Feb 17, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1245823558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 S CHAMISA DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875089149",
            "telephone_number": "303-506-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 S CHAMISA DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875089149",
            "telephone_number": "303-506-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDRICH",
        "first_name": "BRIAN",
        "middle_name": "RUSSELL",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "62824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdiedrich@phs.org",
            "affiliation": "N",
            "endpointDescription": "PHS emal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "23 S Chamisa Dr",
            "city": "Santa Fe",
            "state": "NM",
            "country_code": "US",
            "postal_code": "875089149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tod L Dicecco, LPCC
• Mary Josephine Dickerson
• Denise Anne Dickey, L.P.C.
• Jane Dickinson, NCSP
• Carol Dieckmann, LPCC
• Michelle Diggs
• Digital Care Team of NM LLC
• Stephanie Dilorio, LMHC
• Gina Dimaculangan
• Marguerite Dimas, MS LPCC LADAC

• Family Nurse Practitioner in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.