Provider Demographics
NPI:1376687046
Name:RITTER, GARY (CRNA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:RITTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E BROADWAY AVENUE
Mailing Address - Street 2:P.O. BOX 5510
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58506-5510
Mailing Address - Country:US
Mailing Address - Phone:701-530-7000
Mailing Address - Fax:701-853-8842
Practice Address - Street 1:900 E BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-530-7000
Practice Address - Fax:701-853-8842
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR13386367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14374Medicaid
NDR13386OtherLICENSE
NDR13386OtherLICENSE