ELIZABETH JEAN DIETRICH PA NPI 1811056633

NPI Information

NPI: 1811056633
Provider Name: ELIZABETH JEAN DIETRICH, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
340 9TH ST
FLORENCE, OR
ZIP 97439
Phone: (541) 902-1634
Get Directions

Elizabeth Jean Dietrich, PA is a medical physician assistant in Florence, OR. Elizabeth Jean Dietrich, PA NPI is 1811056633. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

340 9TH ST
FLORENCE, OR
ZIP 97439-470
Phone: (541) 902-1634
Fax: (541) 902-9702

The enumeration date for this NPI number is 12/7/2006 and was last updated on 11/29/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA01118	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200540762RN	OTHER	OREGON	OR STATE BOARD OF NURSING
2	R02181	MEDICARE UPIN
3	PA01118	OTHER	OREGON	OBME LICENSE
4	R137943	MEDICARE PIN	OREGON
5	500632421	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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