Provider Demographics
NPI:1679995435
Name:DITTMAN, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14988 W. FIREWEED DR.
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652
Mailing Address - Country:US
Mailing Address - Phone:907-232-9055
Mailing Address - Fax:
Practice Address - Street 1:14988 W. FIREWEED DR.
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:AK
Practice Address - Zip Code:99652
Practice Address - Country:US
Practice Address - Phone:907-232-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK32843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse