MEDICARE: RITA NTIM STNA

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	376K00000X	Nurse's Aide	400748000508	OH

General Provider Information

NPI Number	:	1972747301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA NTIM STNA

Provider Business Mailing Address
First Line	:	3222 SUMMERHILL LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-4634
Country	:	US
Telephone Number	:	614-772-1676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3222 SUMMERHILL LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-4632
Country	:	US
Telephone Number	:	614-772-1676
Fax Number	:

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

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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