| Michelle Diedrichsen | |
|
295 E Park St Fallon NV 89406-3417 | |
| (775) 426-9319 | |
| Not Available |
| Full Name | Michelle Diedrichsen |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 295 E Park St, Fallon, Nevada |
| Authorized Official Name and Position | Michelle Lauren Diedrichsen (BST) |
| Authorized Official Contact | 7754269319 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michelle Diedrichsen 295 E Park St Fallon NV 89406-3417 Ph: (775) 426-9319 | Michelle Diedrichsen 295 E Park St Fallon NV 89406-3417 Ph: (775) 426-9319 |
| NPI Number | 1063805760 |
|---|---|
| Provider Enumeration Date | 03/05/2015 |
| Last Update Date | 03/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063805760 | NPI | - | NPPES |
| 530557121 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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