Provider Demographics
NPI:1043815616
Name:RIDDLE, CHRISTINA LYNN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 FORK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-3137
Mailing Address - Country:US
Mailing Address - Phone:304-843-1111
Mailing Address - Fax:
Practice Address - Street 1:4205 RINES RIDGE RD
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:WV
Practice Address - Zip Code:26055-4042
Practice Address - Country:US
Practice Address - Phone:304-843-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant