Provider Demographics
NPI:1174178784
Name:RITZENDOLLAR, CHELSEA MONIQUE (APRN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MONIQUE
Last Name:RITZENDOLLAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MONIQUE
Other - Last Name:HINDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:FORT SUPPLY
Mailing Address - State:OK
Mailing Address - Zip Code:73841-0061
Mailing Address - Country:US
Mailing Address - Phone:580-766-2224
Mailing Address - Fax:580-766-2908
Practice Address - Street 1:3946 U.S. HIGHWAY 270
Practice Address - Street 2:
Practice Address - City:FORT SUPPLY
Practice Address - State:OK
Practice Address - Zip Code:73841-9718
Practice Address - Country:US
Practice Address - Phone:580-766-2224
Practice Address - Fax:580-766-2908
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91884363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health