Georgia R. Ditzenberger, NNP-BC, PHD

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

3563-033 Issued in WI

Practice address

202 S Park St
Madison, WI 53715-1507

Phone

(608) 417-6236

Fax

(608) 417-6377

NPI assigned

Feb 8, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1043351778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531",
            "telephone_number": "608-829-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151507",
            "telephone_number": "608-417-6236",
            "fax_number": "608-417-6377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITZENBERGER",
        "first_name": "GEORGIA",
        "middle_name": "R.",
        "name_prefix": "Ms.",
        "credential": "NNP-BC, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "OR",
            "license": "093006205N9 NNP-PP",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "WI",
            "license": "3563-033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Joy Ditlow, LPC
• Casey Ditroia, DPT
• Olivia M Dittmann, NP
• Sarah Dittmann, APNP
• Kim Lynnette Dittus, MD, PHD
• Jessica Lynne Ditzler, FNP
• Divine Haven LLC
• Cory S Divine, CSAC, LPC
• Elizabeth A Divyak, PA-C
• Katharine M Divyak, CRNA

• Neonatal Nurse Practitioner in Madison, WI
• Providers in Madison, WI by specialty
• Neonatal Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.