Healthcare Provider Details

I. General information

NPI: 1376932194
Provider Name (Legal Business Name): JANE RITTENHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W SANTA FE AVE STE B
GRANTS NM
87020-2525
US

IV. Provider business mailing address

1248 MOUNT TAYLOR AVE
GRANTS NM
87020-3149
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-3672
  • Fax: 505-285-9898
Mailing address:
  • Phone: 505-287-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: