Basic Information
Provider Information
NPI: 1316588270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RITTENHOUSE
FirstName: SARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP - BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 844 OLD TUNNEL RD
Address2:  
City: GRASS VALLEY
State: CA
PostalCode: 959458524
CountryCode: US
TelephoneNumber: 5302749762
FaxNumber: 5302737255
Practice Location
Address1: 844 OLD TUNNEL RD
Address2:  
City: GRASS VALLEY
State: CA
PostalCode: 959458524
CountryCode: US
TelephoneNumber: 5302749762
FaxNumber: 5302737255
Other Information
ProviderEnumerationDate: 10/02/2019
LastUpdateDate: 09/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN2319652MAN Nursing Service ProvidersRegistered Nurse 
363LF0000XRN2319652MAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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