Provider Demographics
NPI:1376542613
Name:RITTENHOUSE, MONA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:L
Last Name:RITTENHOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 N LIDGERWOOD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1124
Mailing Address - Country:US
Mailing Address - Phone:509-482-4402
Mailing Address - Fax:509-482-5071
Practice Address - Street 1:6002 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1124
Practice Address - Country:US
Practice Address - Phone:509-482-4402
Practice Address - Fax:509-482-5071
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8321846Medicaid
WA8852018Medicare ID - Type Unspecified
WA8321846Medicaid