Basic Information
| Provider Information | |||||||||
| NPI: | 1093784357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RITENOUR | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 EAST KEN PRATT PARKWAY | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207187000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1750 E KEN PRATT BLVD | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805045311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207187000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 06/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 10312 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR0058855 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00014354 | 01 | NH | RR MEDICARE | OTHER | 30200035 | 05 | NH | MEDICAID |