Dietrick, David Alan

Dietrick, David Alan is an sole proprietor health care provider with primary practice located at 184 Liberty St , New Haven CT 06519-1625. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Dietrick, David Alan can be contacted via phone (203) 688-9791.

Contact Information

Primary practice address
184 Liberty St New Haven CT 06519-1625
Phone: (203) 688-9791
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 004178 Connecticut

Profile Details

NPI number 1922492974
LBN Legal business name Dietrick, David Alan
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 26th, 2015
Last updated Sep 30th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922492974 NPPES
Connecticut MEDICAID 008058287

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