Individual ProviderLee A DiederickNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address737 Broadway, Fargo, ND 58122-0001(701) 234-6258PECOS EnrollmentBased on the most recent information from CMS, provider Lee A Diederick does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:59 PM.Profile DetailsProvider ID1699792556Provider TypeIndividualFull NameDiederick, Lee ACredentialCRNAGenderMaleSole ProprietorNoEnumeration Date7/16/2006Last Updated9/24/2008Contact InformationPractice LocationPractice Address737 Broadway, Fargo, ND 58122-0001Phone(701) 234-6258Fax(701) 234-2345Mailing LocationMailing Address737 Broadway, Fargo, ND 58122-0001Phone(701) 234-6258Fax(701) 234-2345Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR15726North Dakota