Provider Demographics
NPI:1275598344
Name:RIDLER, JENIFER (NP)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:
Last Name:RIDLER
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 1:2570 DODGE RD
Mailing Address - Street 2:
Mailing Address - City:E AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1308
Mailing Address - Country:US
Mailing Address - Phone:716-862-6778
Mailing Address - Fax:716-862-6777
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-6778
Practice Address - Fax:716-862-6777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301676-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health