Provider Demographics
NPI:1356464457
Name:DITTRICH, DARLENE YVONNE (LPN)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:YVONNE
Last Name:DITTRICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 AQUAHART RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3961
Mailing Address - Country:US
Mailing Address - Phone:410-222-6625
Mailing Address - Fax:410-222-6679
Practice Address - Street 1:791 AQUAHART RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3961
Practice Address - Country:US
Practice Address - Phone:410-222-6625
Practice Address - Fax:410-222-6679
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP16084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse