Provider Demographics
NPI:1912294083
Name:THEODORE, MELISSA RITZMAN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RITZMAN
Last Name:THEODORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:RITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2662 N ORCHARD ST UNIT 1
Mailing Address - Street 2:SUITE 1156
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1518
Mailing Address - Country:US
Mailing Address - Phone:773-220-7552
Mailing Address - Fax:
Practice Address - Street 1:4600 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4510
Practice Address - Country:US
Practice Address - Phone:773-561-6282
Practice Address - Fax:773-561-7612
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-008739363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health