Healthcare Provider Details

I. General information

NPI: 1083776462
Provider Name (Legal Business Name): DANIEL E RITTENHOUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8283 RIVERSIDE DR
POWELL OH
43065-7540
US

IV. Provider business mailing address

8283 RIVERSIDE DR
POWELL OH
43065-7540
US

V. Phone/Fax

Practice location:
  • Phone: 614-440-3355
  • Fax:
Mailing address:
  • Phone: 614-440-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN290614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: