Provider Demographics
NPI:1114209368
Name:RIDENBAUGH, CHERYL L (CNM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:RIDENBAUGH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9231 HORN RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-1441
Mailing Address - Country:US
Mailing Address - Phone:330-206-3304
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-4503
Practice Address - Country:US
Practice Address - Phone:330-206-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010252367A00000X
OHAPRN.CNM.13289367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069383Medicaid
OH0069383Medicaid