MEDICARE: GRENETTA L RITENOUR CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP07618	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.07618	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891781696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRENETTA L RITENOUR CNP

Provider Business Mailing Address
First Line	:	4940 COTTONVILLE RD
Second Line	:
City	:	JAMESTOWN
State	:	OH
Zip	:	45335-1522
Country	:	US
Telephone Number	:	937-675-2870
Fax Number	:	937-675-2873

Provider Business Practice Location Address
First Line	:	4940 COTTONVILLE RD
Second Line	:
City	:	JAMESTOWN
State	:	OH
Zip	:	45335-1522
Country	:	US
Telephone Number	:	937-675-2870
Fax Number	:	937-675-2873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	05/30/2024

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