Healthcare Provider Details

I. General information

NPI: 1861734675
Provider Name (Legal Business Name): MICHELE E RIDER TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 KUENZLI ST
RENO NV
89502-1117
US

IV. Provider business mailing address

3225 DELNA DR
SPARKS NV
89431-1406
US

V. Phone/Fax

Practice location:
  • Phone: 775-334-0907
  • Fax: 775-334-4356
Mailing address:
  • Phone: 775-835-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: