Healthcare Provider Details

I. General information

NPI: 1376420406
Provider Name (Legal Business Name): NONIE DARLENE RIUTTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53584 BIG TRAVERSE RIVER RD
LAKE LINDEN MI
49945
US

IV. Provider business mailing address

53584 BIG TRAVERSE RIVER RD
LAKE LINDEN MI
49945
US

V. Phone/Fax

Practice location:
  • Phone: 906-369-3913
  • Fax:
Mailing address:
  • Phone: 906-369-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704281199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: