1275865180 NPI number — HANNAH A DITMARS BUCKWALTER AUD

Table of content: MRS. DIANA ROSE MITCHELL RITTER MOT, OTR/L (NPI 1568917102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275865180 NPI number — HANNAH A DITMARS BUCKWALTER AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DITMARS BUCKWALTER
Provider First Name:
HANNAH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DITMARS
Provider Other First Name:
HANNAH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275865180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 830738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68583-0731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-472-2071
Provider Business Mailing Address Fax Number:
402-472-3814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3835 HOLDREGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68583-0731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-472-2071
Provider Business Practice Location Address Fax Number:
402-472-3814
Provider Enumeration Date:
02/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  279 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: 102 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102 . This is a "HEARING INSTRUMENT SPECIALIST/A" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 279 . This is a "NEBRASKA STATE AUDIOLOGY LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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