Provider Demographics
NPI:1659777845
Name:RITTENOUR, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:RITTENOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 E HEGLAR RD
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-7736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11815 E HEGLAR RD
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021
Practice Address - Country:US
Practice Address - Phone:509-220-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00080208163W00000X, 163WC1500X
WAMW60901030176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health