Provider Demographics
NPI:1124010103
Name:GRISSETT, RITCHIE DEAN
Entity Type:Individual
Prefix:MR
First Name:RITCHIE
Middle Name:DEAN
Last Name:GRISSETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4194 WINTER FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-4122
Mailing Address - Country:US
Mailing Address - Phone:937-694-8025
Mailing Address - Fax:
Practice Address - Street 1:4194 WINTER FOREST CIR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-4122
Practice Address - Country:US
Practice Address - Phone:937-431-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.270351367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered