Provider Demographics
NPI:1669587713
Name:DESJARDINS-RITCHIE, LISA (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DESJARDINS-RITCHIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 NORTHERN BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5334
Mailing Address - Country:US
Mailing Address - Phone:516-773-6300
Mailing Address - Fax:516-706-4700
Practice Address - Street 1:891 NORTHERN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5334
Practice Address - Country:US
Practice Address - Phone:516-773-6300
Practice Address - Fax:516-706-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF332718 / 443990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse