Provider Demographics
NPI:1245549872
Name:RITZE, LYNDSEY BROOKE (PA-C)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:BROOKE
Last Name:RITZE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:BROOKE
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B2ND
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3191
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:2300 MIAMI VALLEY DR STE 350
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-1294
Practice Address - Country:US
Practice Address - Phone:937-424-2469
Practice Address - Fax:937-424-2479
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117086Medicaid