Provider Demographics
NPI:1093958779
Name:RIDDLE, CHARLOTTE E (CRNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:E
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 ZIMMERLY RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-6213
Mailing Address - Country:US
Mailing Address - Phone:814-454-1085
Mailing Address - Fax:
Practice Address - Street 1:3250 W LAKE RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3691
Practice Address - Country:US
Practice Address - Phone:814-454-1085
Practice Address - Fax:814-240-3976
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily