Healthcare Provider Details

I. General information

NPI: 1376687046
Provider Name (Legal Business Name): GARY RITTER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVENUE
BISMARCK ND
58501
US

IV. Provider business mailing address

900 E BROADWAY AVENUE P.O. BOX 5510
BISMARCK ND
58506-5510
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-7000
  • Fax: 701-853-8842
Mailing address:
  • Phone: 701-530-7000
  • Fax: 701-853-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR13386
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: