Provider Demographics
NPI:1962803643
Name:RITENOUR, CARRIE M (PA-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:RITENOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NATURE PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6960
Mailing Address - Country:US
Mailing Address - Phone:724-836-5540
Mailing Address - Fax:724-836-5548
Practice Address - Street 1:118 NATURE PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6960
Practice Address - Country:US
Practice Address - Phone:724-836-5540
Practice Address - Fax:724-836-5548
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103204802Medicaid
13664827OtherCAQH
PA103204802Medicaid