Healthcare Provider Details

I. General information

NPI: 1760580708
Provider Name (Legal Business Name): DEBORAH J RIDDELL APN. CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 INDIAN TRAIL ROAD SUITE A
AURORA IL
60502
US

IV. Provider business mailing address

2040 OGDEN AVENUE SUITE 313
AURORA IL
60504
US

V. Phone/Fax

Practice location:
  • Phone: 630-897-7700
  • Fax: 630-897-7701
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number309001170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: