Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | TP004431C | PA |
NPI | 1699767459 |
---|---|
Provider Name | Barbara Rideout |
First Address | Philadelphia, PA 19131-1205 |
Second Address | Philadelphia, PA 19123-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 08/07/2007 |