Provider Demographics
NPI:1649088394
Name:ELLWANGER, DEETT DARLA
Entity type:Individual
Prefix:
First Name:DEETT
Middle Name:DARLA
Last Name:ELLWANGER
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 1:1211 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4924
Mailing Address - Country:US
Mailing Address - Phone:402-984-9989
Mailing Address - Fax:
Practice Address - Street 1:1211 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4924
Practice Address - Country:US
Practice Address - Phone:402-984-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion