Provider Demographics
NPI:1184015075
Name:RIDENOUR, ELIN
Entity Type:Individual
Prefix:
First Name:ELIN
Middle Name:
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 GLENCOE HILLS DR APT 10
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1086
Mailing Address - Country:US
Mailing Address - Phone:734-255-6897
Mailing Address - Fax:
Practice Address - Street 1:2123 GLENCOE HILLS DR APT 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1086
Practice Address - Country:US
Practice Address - Phone:734-255-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288620163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse