Christine Marie Dietrich, APRN, GNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

2004-33 Issued in WI

Practice address

303 W Upham St Ste 200
Marshfield, WI 54449-1483

Phone

(715) 204-8555

Fax

(715) 384-8046

NPI assigned

Jun 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1376747261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W UPHAM ST STE 200",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544491483",
            "telephone_number": "715-301-7270",
            "fax_number": "715-384-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 W UPHAM ST STE 200",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544491483",
            "telephone_number": "715-204-8555",
            "fax_number": "715-384-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APRN, GNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R200410-1",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "2004-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "004881926",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376747261",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376747261",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edna O Devries, MD
• Troy Donald Deyoung, CRNA
• Margo Elaine Diamond-Robertson
• Julene Diedrich, NP
• Jacob William Diestelmann, PH.D.
• Julie C Dietz, MD
• Ade R Dillon, MD
• Wesley William Dittman
• Matthew J Dombrowski, PA-C
• Heather Donald, M.S. CCC/SLP

• All providers in Marshfield, WI
• Gerontology Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.