Provider Demographics
NPI:1578926747
Name:RITENOUR, GEORGIANN (RN)
Entity Type:Individual
Prefix:
First Name:GEORGIANN
Middle Name:
Last Name:RITENOUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3308
Mailing Address - Country:US
Mailing Address - Phone:724-430-2444
Mailing Address - Fax:724-430-2445
Practice Address - Street 1:160 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3308
Practice Address - Country:US
Practice Address - Phone:724-430-2444
Practice Address - Fax:724-430-2445
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21333601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102628104Medicaid