Provider Demographics
NPI:1356821383
Name:RITZHEIMER, NATALIE ANN (PA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:RITZHEIMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:6812 STATE ROUTE 162 STE 202
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8562
Practice Address - Country:US
Practice Address - Phone:618-288-6844
Practice Address - Fax:618-288-6852
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.006773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant