Provider Demographics
NPI: | 1225005390 |
---|---|
Name: | RIDGWAY, ONA LUCIA (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | ONA |
Middle Name: | LUCIA |
Last Name: | RIDGWAY |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 130 |
Mailing Address - Street 2: | |
Mailing Address - City: | FRUITA |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81521-0130 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-858-2186 |
Mailing Address - Fax: | 970-858-2208 |
Practice Address - Street 1: | 281 N PLUM ST |
Practice Address - Street 2: | |
Practice Address - City: | FRUITA |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81521 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-858-9894 |
Practice Address - Fax: | 970-858-1331 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-07 |
Last Update Date: | 2020-11-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | APN.0004533-NP | 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 43689264 | Medicaid | |
CO | 43689264 | Medicaid | |
CO | 1225005390 | Medicare PIN |