Provider Demographics
NPI:1942587134
Name:RITTENBERG, LISA B (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:RITTENBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PORT SIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3009
Mailing Address - Country:US
Mailing Address - Phone:954-818-6348
Mailing Address - Fax:
Practice Address - Street 1:1011 NW 51ST ST UNIT 6
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3173
Practice Address - Country:US
Practice Address - Phone:305-908-1367
Practice Address - Fax:954-318-0878
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1618432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse