Provider Demographics
NPI:1720377286
Name:RIBITZKI, NADEAN (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:NADEAN
Middle Name:
Last Name:RIBITZKI
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3555
Mailing Address - Country:US
Mailing Address - Phone:501-733-8162
Mailing Address - Fax:888-908-7597
Practice Address - Street 1:1125 SALEM RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3555
Practice Address - Country:US
Practice Address - Phone:501-733-8162
Practice Address - Fax:888-908-7597
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR112010176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife