Provider Demographics
NPI:1730981044
Name:BOURNE-RITENOUR, VICKI JO
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:JO
Last Name:BOURNE-RITENOUR
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 1:16173 GROVE RD SE
Mailing Address - Street 2:PERRY TOWNSHIP RD 142
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43837-9171
Mailing Address - Country:US
Mailing Address - Phone:330-934-7105
Mailing Address - Fax:
Practice Address - Street 1:16173 GROVE RD SE
Practice Address - Street 2:PERRY TOWNSHIP RD 142
Practice Address - City:PORT WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43837-9171
Practice Address - Country:US
Practice Address - Phone:330-934-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant