Provider Demographics
NPI:1104194125
Name:RIDER, MELISSA GAIL (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:RIDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 CAHABA ST.
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-979-6820
Mailing Address - Fax:315-348-2510
Practice Address - Street 1:4264 EAST RD
Practice Address - Street 2:
Practice Address - City:TURIN
Practice Address - State:NY
Practice Address - Zip Code:13473-0040
Practice Address - Country:US
Practice Address - Phone:315-348-2500
Practice Address - Fax:315-348-2510
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY575636163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool