MEDICARE: LISA B RITTENBERG RN

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	163W00000X	Registered Nurse	RN1618432	FL

General Provider Information

NPI Number	:	1942587134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B RITTENBERG RN

Provider Business Mailing Address
First Line	:	8 PORT SIDE DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3009
Country	:	US
Telephone Number	:	954-818-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 NW 51ST ST UNIT 6
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3173
Country	:	US
Telephone Number	:	305-908-1367
Fax Number	:	954-318-0878

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

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	11/16/2011

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