MEDICARE: TERI RIDGEWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	202966	CO

General Provider Information

NPI Number	:	1477814721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI RIDGEWAY

Provider Business Mailing Address
First Line	:	220 RUSKIN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6208 LEHMAN DR STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8404
Country	:	US
Telephone Number	:	719-572-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	06/04/2012

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Directions to “ TERI RIDGEWAY ” Practice Location

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