1831238963 NPI number — CASSANDRA M DITTMER M.S.

Table of content: CASSANDRA M DITTMER M.S. (NPI 1831238963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831238963 NPI number — CASSANDRA M DITTMER M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DITTMER
Provider First Name:
CASSANDRA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831238963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 PIONEERS BLVD
Provider Second Line Business Mailing Address:
STE 112
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68502-5963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-486-3110
Provider Business Mailing Address Fax Number:
402-486-3127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 PIONEERS BLVD
Provider Second Line Business Practice Location Address:
STE 112
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68502-5963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-486-3110
Provider Business Practice Location Address Fax Number:
402-486-3127
Provider Enumeration Date:
02/05/2007

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: 101YM0800X , with the licence number:  3406 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 129 , 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: 96065 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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