Provider Demographics
NPI:1245127380
Name:DIBBERN, CARMEN M
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:DIBBERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:M
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3176 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1909
Mailing Address - Country:US
Mailing Address - Phone:402-601-0401
Mailing Address - Fax:
Practice Address - Street 1:3176 N 40TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1909
Practice Address - Country:US
Practice Address - Phone:402-601-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker