Provider Demographics
NPI:1124114350
Name:RITTER, PHOEBE LYNN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PHOEBE
Middle Name:LYNN
Last Name:RITTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14590 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9705
Mailing Address - Country:US
Mailing Address - Phone:574-259-1455
Mailing Address - Fax:
Practice Address - Street 1:5735 S IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-9668
Practice Address - Country:US
Practice Address - Phone:574-299-4847
Practice Address - Fax:574-299-9073
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001107A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily