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NPI Code Detail

MEDICARE: BARBARA RIDEOUT C.R.N.P.

MEDICARE: BARBARA RIDEOUT C.R.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LC1500XCommunity Health Nurse PractitionerTP004431CPA

General Provider Information

NPI Number : 1699767459
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARBARA RIDEOUT C.R.N.P.
Provider Business Mailing Address
First Line : 5843 WOODBINE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19131-1205
Country : US
Telephone Number : 215-877-8257
Fax Number :
Provider Business Practice Location Address
First Line : 850 N 11TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19123-1957
Country : US
Telephone Number : 215-769-1100
Fax Number : 215-769-1117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 07/08/2007

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Directions to “ BARBARA RIDEOUT C.R.N.P.” Practice Location

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