Provider Demographics
NPI:1811326564
Name:DITTES, GAIL (RN IBCLC)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:DITTES
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SHELLFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1707
Mailing Address - Country:US
Mailing Address - Phone:267-879-5000
Mailing Address - Fax:267-393-4500
Practice Address - Street 1:17 SHELLFLOWER RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1707
Practice Address - Country:US
Practice Address - Phone:267-241-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-46563163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant