Provider Demographics
NPI:1083074751
Name:RIDDER, LEAH B (APRN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:B
Last Name:RIDDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:B
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:16909 LAKESIDE HILLS CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4664
Mailing Address - Country:US
Mailing Address - Phone:402-758-5400
Mailing Address - Fax:
Practice Address - Street 1:16909 LAKESIDE HILLS CT
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4664
Practice Address - Country:US
Practice Address - Phone:402-758-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098684824Medicare PIN