Active NPI
Renee L Dietrich
- Family Nurse Practitioner
- Menominee, MI
National Provider Identifier
1821377177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 7315-33
- Practice address
- 1110 10TH Ave Ste 101
Menominee, MI 49858-3058 - Phone
- (906) 863-1286
- NPI assigned
- Aug 4, 2011
- Last updated
- Apr 17, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 088583 | IA | |
| Family Nurse Practitioner | 363LF0000X | 7315-33 | WI | Primary |
Addresses
Primary practice location
1110 10TH Ave Ste 101
Menominee, MI 49858-3058
Mailing address
325 E H St
Iron Mountain, MI 49801-4760
Phone (906) 774-3300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7315-33 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affordable Medical Care LLC | Past | Accepting new patients | |
| Winnebago Indian Health Service | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587081600000",
"number": "1821377177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014760",
"telephone_number": "906-774-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 10TH AVE STE 101",
"city": "MENOMINEE",
"state": "MI",
"postal_code": "498583058",
"telephone_number": "906-863-1286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "RENEE",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-04",
"last_updated": "2020-04-17",
"certification_date": "2020-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IA",
"license": "088583",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "7315-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menominee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.