Provider Demographics
NPI:1255118576
Name:RITZ, MIRANDA ROSE (APRN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ROSE
Last Name:RITZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 POTTER RD S
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-9722
Mailing Address - Country:US
Mailing Address - Phone:170-429-0810
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE L203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6754
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRITZ-Q8V8N363LF0000X
KY4009533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily