Provider Demographics
NPI:1043513963
Name:SHRIDER, RHONDA S (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:S
Last Name:SHRIDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 OAK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-8526
Mailing Address - Country:US
Mailing Address - Phone:419-633-7370
Mailing Address - Fax:
Practice Address - Street 1:102 OAK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-8526
Practice Address - Country:US
Practice Address - Phone:419-633-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN054309-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse