Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 000-00-4767 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP1993 | AZ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP30005175 | WA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 66740254405 | UT |
NPI | 1033205281 |
---|---|
Provider Name | Ms. Karen Sunny Ridenour |
First Address | Mesa, AZ 85215-1214 |
Second Address | Tucson, AZ 85748-6631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
876196 | (05) | AZ |
S93339 | (02) | AZ |