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Dennis Dietzen
Clinical Laboratory Director (Non-physician) in Glen Carbon, Illinois
NPI 1598475592

Dennis Dietzen is a Clinical Laboratory Director (Non-physician) based in Glen Carbon, IL and is specialized in Clinical Laboratory Director, Non-physician. Dennis Dietzen practices in Glen Carbon, IL. The NPI Number for Dennis Dietzen is 1598475592 and holds a License No. (Illinois).

The current practice location address for Dennis Dietzen is 203 Sierra Pt, Glen Carbon, IL and can be reached out via phone at 618-971-8827.

Location: 203 Sierra Pt, Glen Carbon, IL, 62034-1346
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1598475592
Provider Name
Dennis Dietzen
Credential
Provider Entity Type
Individual
Gender
Male
Address
203 Sierra Pt, Glen Carbon, IL, 62034-1346
Phone Number
618-971-8827
Fax Number
Provider Enumeration Date
11/30/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
203 Sierra Pt
City
Glen Carbon
State
Illinois
Zip
62034-1346
Phone Number
618-971-8827
Fax Number
person
Provider Business Mailing Address Details
Address
203 Sierra Pt
City
Glen Carbon
State
Illinois
Zip
62034-1346
Phone Number
618-971-8827
Fax Number
person
Provider's Taxonomy Details 1
Type
Technologists, Technicians & Other Technical Service Providers
Classification
Technician, Pathology
Speciality
Clinical Laboratory Director, Non-physician
Taxonomy
247ZC0005X
License No.
()
Definition
An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405.
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