Provider Demographics
NPI:1215725098
Name:DIETZ, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:DIETZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 Q ST STE 101C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3700
Mailing Address - Country:US
Mailing Address - Phone:402-697-5121
Mailing Address - Fax:
Practice Address - Street 1:916 WOODHURST AVE APT 21
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2478
Practice Address - Country:US
Practice Address - Phone:402-860-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH133470543747P1801X, 372500000X, 372600000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion