Provider Demographics
NPI:1225064983
Name:ETHRIDGE, APRIL SUSAN (PA)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:SUSAN
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:72785 FRANK SINATRA DR STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3207
Practice Address - Country:US
Practice Address - Phone:760-969-5900
Practice Address - Fax:760-969-5911
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA970024662OtherRAILROAD MEDICARE
CAME1398595OtherDRUG ENFORCEMENT ADMINISTRATION
CABN526ZMedicare PIN
CAP53383Medicare UPIN