Healthcare Provider Details

I. General information

NPI: 1174178784
Provider Name (Legal Business Name): CHELSEA MONIQUE RITZENDOLLAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA MONIQUE HINDERMAN

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 U.S. HIGHWAY 270
FORT SUPPLY OK
73841-9718
US

IV. Provider business mailing address

PO BOX 61
FORT SUPPLY OK
73841-0061
US

V. Phone/Fax

Practice location:
  • Phone: 580-766-2224
  • Fax: 580-766-2908
Mailing address:
  • Phone: 580-766-2224
  • Fax: 580-766-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number91884
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: