Provider Demographics
NPI:1184298028
Name:RITCHIE, DANA LAREE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LAREE
Last Name:RITCHIE
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 1:13541 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47974-8093
Mailing Address - Country:US
Mailing Address - Phone:812-229-0492
Mailing Address - Fax:
Practice Address - Street 1:404 W 9TH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IL
Practice Address - Zip Code:61846-1419
Practice Address - Country:US
Practice Address - Phone:217-474-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.074239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse