Provider Demographics
NPI:1134541030
Name:DITTENHOFER, GINGER
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:DITTENHOFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 ROLLING WOODS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1900
Mailing Address - Country:US
Mailing Address - Phone:304-308-7608
Mailing Address - Fax:
Practice Address - Street 1:5 ROLLING WOODS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-1900
Practice Address - Country:US
Practice Address - Phone:304-308-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656617-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse