Provider Demographics
NPI:1114362209
Name:RIDGE, NANCY CHARLENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CHARLENE
Last Name:RIDGE
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 1:3113 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-4139
Mailing Address - Country:US
Mailing Address - Phone:803-321-2621
Mailing Address - Fax:
Practice Address - Street 1:3113 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-4139
Practice Address - Country:US
Practice Address - Phone:803-321-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse