Healthcare Provider Details

I. General information

NPI: 1982417069
Provider Name (Legal Business Name): AMANDA ROCHELLE RITZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 11TH ST N
COLUMBUS MT
59019-7215
US

IV. Provider business mailing address

15 BACKFORTY RD
PARK CITY MT
59063-8092
US

V. Phone/Fax

Practice location:
  • Phone: 406-322-1000
  • Fax:
Mailing address:
  • Phone: 320-309-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-126545
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: