Healthcare Provider Details

I. General information

NPI: 1033349378
Provider Name (Legal Business Name): LUDMILA DITTRICH MICHELS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011
APO AP
96343-5011
US

IV. Provider business mailing address

CMR 402 LANDSTUHL REGIONAL MEDICAL CENTER
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-4127
  • Fax:
Mailing address:
  • Phone: 496371868440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number533360
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number533360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: