Provider Demographics
NPI:1265440945
Name:DITTMAR, MARGARET E (MS, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:E
Last Name:DITTMAR
Suffix:
Gender:F
Credentials:MS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-8118
Mailing Address - Country:US
Mailing Address - Phone:815-776-7381
Mailing Address - Fax:815-776-7385
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-8118
Practice Address - Country:US
Practice Address - Phone:815-776-7381
Practice Address - Fax:815-776-7381
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-076862363L00000X
IL209006033363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ70901Medicare UPIN
ILK36653Medicare ID - Type Unspecified