Healthcare Provider Details

I. General information

NPI: 1235274606
Provider Name (Legal Business Name): PATRICIA RIDING R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 TOPAZ BLVD # 4
DELTA UT
84624-9128
US

IV. Provider business mailing address

PO BOX 443
DELTA UT
84624-0443
US

V. Phone/Fax

Practice location:
  • Phone: 435-864-3612
  • Fax: 435-864-3612
Mailing address:
  • Phone: 435-864-3612
  • Fax: 435-864-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number190182-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: