Provider Demographics
NPI:1013681295
Name:INGERSOLL, RITA MARIE (RN, BSN, CCM)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:MARIE
Last Name:INGERSOLL
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463173
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48046-3173
Mailing Address - Country:US
Mailing Address - Phone:586-201-4177
Mailing Address - Fax:586-329-3241
Practice Address - Street 1:665 WELLINGTON CRES
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2950
Practice Address - Country:US
Practice Address - Phone:586-201-4177
Practice Address - Fax:586-329-3241
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704166753163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management