Healthcare Provider Details

I. General information

NPI: 1790243491
Provider Name (Legal Business Name): ELLEN RITTENHOUSE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W MICHIGAN AVE
KALAMAZOO MI
49006-5810
US

IV. Provider business mailing address

1115 N BLACK RIVER DR APT 5
HOLLAND MI
49424-9164
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-1200
  • Fax:
Mailing address:
  • Phone: 810-956-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704312239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: