Healthcare Provider Details

I. General information

NPI: 1730851775
Provider Name (Legal Business Name): STEPHANIE RITTMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ROBINSON AVE
CONWAY AR
72034-4945
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-548-6100
  • Fax: 501-548-6105
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-CNP215197
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: