Provider Demographics
NPI:1982417069
Name:RITZER, AMANDA ROCHELLE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROCHELLE
Last Name:RITZER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BACKFORTY RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59063-8092
Mailing Address - Country:US
Mailing Address - Phone:320-309-9084
Mailing Address - Fax:
Practice Address - Street 1:710 11TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-7215
Practice Address - Country:US
Practice Address - Phone:406-322-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-126545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse