Provider Demographics
NPI:1720657190
Name:DITTMER, HELEN (MSN, DNS-CT, RN)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:DITTMER
Suffix:
Gender:F
Credentials:MSN, DNS-CT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1524
Mailing Address - Country:US
Mailing Address - Phone:815-316-1542
Mailing Address - Fax:815-316-6060
Practice Address - Street 1:4141 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1593
Practice Address - Country:US
Practice Address - Phone:815-316-1542
Practice Address - Fax:815-316-6060
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041346844163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology