Provider Demographics
NPI:1609819754
Name:DIETERLE, NATALIE (PA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DIETERLE
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:612-676-8992
Practice Address - Street 1:516 DELAWARE STREET SE, CLINIC 5B
Practice Address - Street 2:BLOOD AND MARROW TRANSPLANT (BMT CLINIC)
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-2663
Practice Address - Fax:612-626-2664
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004075363A00000X
MN11028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant