Provider Demographics
NPI:1710365085
Name:ORTIZ-RITCHEY, LIDIA J (APN)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:J
Last Name:ORTIZ-RITCHEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4812
Mailing Address - Country:US
Mailing Address - Phone:312-549-4400
Mailing Address - Fax:
Practice Address - Street 1:539 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4812
Practice Address - Country:US
Practice Address - Phone:312-549-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012036041364106363LP2300X
IL209012036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400213130OtherMEDICARE PTAN