C Jean Dittmann, LPN
Individual provider Active NPI Licensed Practical Nurse · Clinton, WI
NPI 1487843538 · NPPES record last updated Oct 15, 2007
Key facts
- NPI
- 1487843538
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- Practice address
- 208 Ogden Ave
Apt 4
Clinton, WI 53525-9036 - Phone
- (608) 676-6127
- NPI assigned
- Oct 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043-043153 | IL | MD | Licensed Practical Nurse |
| 309155-031 | WI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | WI | Yes | |
| Licensed Practical Nurse | 164W00000X | IL |
Addresses
Primary practice location
208 Ogden Ave
Apt 4
Clinton, WI 53525-9036
Mailing address
208 Ogden Ave
Apt 4
Clinton, WI 53525-9036
Phone (608) 676-6127
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35043800 | Medicaid | WI |
Other providers in Clinton, WI
- Clinton Fire Protection District
- Clinton Pharmacy LLC
- Lara Damico
- Nicholas Damman
- Brian D Dittmann
- Ashley Ann Furman
- Generations Care Partners Corporation Dba Caring Senior Service Milwau
- Erin Grenawalt
- Brian A Hamann
- Treasa Hendrickson
All providers in Clinton, WI · Licensed Practical Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.