Healthcare Provider Details

I. General information

NPI: 1679388714
Provider Name (Legal Business Name): WHITNEY DYKSTRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N 7TH ST
NORFOLK NE
68701-4047
US

IV. Provider business mailing address

PO BOX 280
WAYNE NE
68787-0280
US

V. Phone/Fax

Practice location:
  • Phone: 402-375-2881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: