Healthcare Provider Details

I. General information

NPI: 1396148987
Provider Name (Legal Business Name): MOLLIE RITCHIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 W NORTH AVE
WAUWATOSA WI
53226-2315
US

IV. Provider business mailing address

4835 STRATFORD DR
GREENDALE WI
53129-2043
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-5350
  • Fax:
Mailing address:
  • Phone: 414-235-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: