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Tamara Ryan Dietze

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as TAMARA DIETZE.

Based on the most recent information from CMS, provider Tamara Ryan Dietze is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1407383920
Provider Type
Individual
Full Name
Dietze, Tamara Ryan
Title
Mrs.
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
5/15/2017
Last Updated
7/14/2017

Contact Information

Practice Location

Emile At 42nd St, Omaha, NE 68198-3771

(402) 552-6732

(402) 559-6779

Mailing Location

988102 Nebraska Medical Ctr, Omaha, NE 68198-8102

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 2129 Nebraska
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Tamara Ryan Dietze

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Mckim, Sheryl Ann

Bradshaw, Reagan Nicole

Bankson, Brianna

Christensen, Abbey

Schneider, Carla J.

Jessen, Carissa J.

Finigan, Amber

Saucier, Delaney Mclane

Polack, Susan H

Lamb, Jackson Forrest