Provider Demographics
NPI:1881233070
Name:TEADTKE, DIANE MARGARET (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARGARET
Last Name:TEADTKE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52518 890 RD
Mailing Address - Street 2:
Mailing Address - City:NIOBRARA
Mailing Address - State:NE
Mailing Address - Zip Code:68760-7003
Mailing Address - Country:US
Mailing Address - Phone:402-857-3350
Mailing Address - Fax:
Practice Address - Street 1:52518 890 RD
Practice Address - Street 2:
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:68760-7003
Practice Address - Country:US
Practice Address - Phone:402-857-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113002363LP0808X
SDCP001711363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health