Provider Demographics
NPI:1760344196
Name:GUTHRIDGE-DIETZE, LAURA MARIE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:GUTHRIDGE-DIETZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:GUTHRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:IA
Mailing Address - Zip Code:52248-0155
Mailing Address - Country:US
Mailing Address - Phone:319-339-7010
Mailing Address - Fax:319-887-4910
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2209
Practice Address - Country:US
Practice Address - Phone:319-339-7010
Practice Address - Fax:319-887-4910
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse