Provider Demographics
NPI:1073666905
Name:RITTER, MARY LOUISE (ANP)
Entity Type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:RITTER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 DAGGETT DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4638
Mailing Address - Country:US
Mailing Address - Phone:413-747-4544
Mailing Address - Fax:
Practice Address - Street 1:46 DAGGETT DR
Practice Address - Street 2:SUITE 3B
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4638
Practice Address - Country:US
Practice Address - Phone:413-747-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA91935363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2553Medicare ID - Type Unspecified
MAP11203Medicare UPIN