Healthcare Provider Details

I. General information

NPI: 1710365085
Provider Name (Legal Business Name): LIDIA J ORTIZ-RITCHEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 N DEARBORN ST
CHICAGO IL
60654-4812
US

IV. Provider business mailing address

539 N DEARBORN ST
CHICAGO IL
60654-4812
US

V. Phone/Fax

Practice location:
  • Phone: 312-549-4400
  • Fax:
Mailing address:
  • Phone: 312-549-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012036
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209012036041364106
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: