Healthcare Provider Details

I. General information

NPI: 1851833032
Provider Name (Legal Business Name): ANNA RIDDELL DO, NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARTIN DO, NMD

II. Dates (important events)

Enumeration Date: 11/05/2016
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 JEFFERSON ST N
LEWISBURG WV
24901-1380
US

IV. Provider business mailing address

1464 JEFFERSON ST N
LEWISBURG WV
24901-1380
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-4411
  • Fax: 844-479-4547
Mailing address:
  • Phone: 304-647-4411
  • Fax: 844-479-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberED01517
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNMD-0042
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: