Basic Information
| Provider Information | |||||||||
| NPI: | 1144892589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIERDORF | ||||||||
| FirstName: | MARJORIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 DENTON DR | ||||||||
| Address2: | |||||||||
| City: | YOE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173131422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3215141366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1550 RODNEY RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174089715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178468791 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2021 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | SP024514 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.