Healthcare Provider Details

I. General information

NPI: 1649345778
Provider Name (Legal Business Name): ABIGAIL M RIEDEL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E STROOP RD
KETTERING OH
45429-3245
US

IV. Provider business mailing address

42 FORRER RD
OAKWOOD OH
45419-3019
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-0199
  • Fax:
Mailing address:
  • Phone: 937-657-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.09006
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.09006
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.09006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: