Provider Demographics
NPI:1144065194
Name:SIDHU, RITA MARIE
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:SIDHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 MONROE ST APT 2-219
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1448
Mailing Address - Country:US
Mailing Address - Phone:313-909-5791
Mailing Address - Fax:
Practice Address - Street 1:6465 MONROE ST APT 219
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1433
Practice Address - Country:US
Practice Address - Phone:313-909-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH479845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse