Provider Demographics
NPI:1417655507
Name:SITTER, KENNETH J
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:SITTER
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 1:217 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-1819
Mailing Address - Country:US
Mailing Address - Phone:701-776-5855
Mailing Address - Fax:
Practice Address - Street 1:217 4TH ST SE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-1819
Practice Address - Country:US
Practice Address - Phone:701-776-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker