Provider Demographics
NPI:1689703159
Name:RITCHIE, M. NANETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:NANETTE
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 7004B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6295
Mailing Address - Fax:314-251-5897
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 7004B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6295
Practice Address - Fax:314-251-5897
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO1102062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG30792Medicare UPIN