Provider Demographics
NPI:1275943862
Name:RIDDER, SUSAN (RN-CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RIDDER
Suffix:
Gender:F
Credentials:RN-CDE
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 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:6901 N 72ND STREET
Practice Address - Street 2:ATTN: DIABETIC EDUCATION
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-398-6255
Practice Address - Fax:402-829-8513
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48755163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator