Individual provider Active NPI

Kristin Ditzel, RN

  • Ambulatory Care Registered Nurse
  • Mineola, NY
National Provider Identifier
1629949672
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Care Registered NurseTaxonomy code 163WP2201X
License
487203-01 Issued in NY
Practice address
259 1St St
Mineola, NY 11501-3957
Phone
(516) 663-2361
NPI assigned
Sep 15, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Care Registered Nurse 163WP2201X 487203-01 NY Primary

Addresses

Primary practice location

259 1St St
Mineola, NY 11501-3957

Mailing address

99 Commonwealth Ave
Massapequa, NY 11758-4139
Phone (516) 663-8120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
487203-01NYMDAmbulatory Care Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1757894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1629949672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 COMMONWEALTH AVE",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117584139",
            "telephone_number": "516-663-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITZEL",
        "first_name": "KRISTIN",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-15",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "NY",
            "license": "487203-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; 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.