Provider Demographics
NPI:1033116108
Name:RITZ, LOUISE C (NP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:C
Last Name:RITZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 SMALLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2519
Mailing Address - Country:US
Mailing Address - Phone:703-587-5983
Mailing Address - Fax:
Practice Address - Street 1:12524 SUNRISE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3438
Practice Address - Country:US
Practice Address - Phone:703-689-2180
Practice Address - Fax:703-481-3853
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007789343Medicaid
VAP45749Medicare UPIN