Provider Demographics
NPI:1841694544
Name:RITTON, HEATHER DANIELLE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DANIELLE
Last Name:RITTON
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 1:2769 ROUTE 168
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:NY
Mailing Address - Zip Code:13407
Mailing Address - Country:US
Mailing Address - Phone:315-866-1469
Mailing Address - Fax:
Practice Address - Street 1:2769 ROUTE 168
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:NY
Practice Address - Zip Code:13407
Practice Address - Country:US
Practice Address - Phone:315-866-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319096-1164W00000X
NY246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy