Provider Demographics
NPI:1114178282
Name:RIDENOUR, WENDY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1100 S DOBSON RD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6157
Mailing Address - Country:US
Mailing Address - Phone:480-821-8888
Mailing Address - Fax:480-821-0888
Practice Address - Street 1:1100 S DOBSON RD
Practice Address - Street 2:SUITE 223
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6157
Practice Address - Country:US
Practice Address - Phone:480-821-8888
Practice Address - Fax:480-821-0888
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4195363A00000X
TX00180553363A00000X
OH50.003768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant