Provider Demographics
NPI:1356516157
Name:RITTER, MARY AYLEENE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:AYLEENE
Last Name:RITTER
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:AYLEENE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPBC
Mailing Address - Street 1:6473 HIGHWAY 44 STE 103
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8179
Mailing Address - Country:US
Mailing Address - Phone:225-257-1040
Mailing Address - Fax:225-257-1043
Practice Address - Street 1:6473 HIGHWAY 44
Practice Address - Street 2:STE 103
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8179
Practice Address - Country:US
Practice Address - Phone:225-257-1040
Practice Address - Fax:225-257-1043
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357006Medicaid
LA3A864Medicare PIN