Provider Demographics
NPI:1487380184
Name:RITZ, AUTUMN MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:MARIE
Last Name:RITZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:AUTUMN
Other - Middle Name:MARIE
Other - Last Name:DEGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 98TH PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3309
Mailing Address - Country:US
Mailing Address - Phone:708-704-8607
Mailing Address - Fax:
Practice Address - Street 1:6701 159TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1758
Practice Address - Country:US
Practice Address - Phone:708-444-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025521363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner