Provider Demographics
NPI:1285015107
Name:RIDDEL, MOLLY RUTH (APRN-CNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:RUTH
Last Name:RIDDEL
Suffix:
Gender:F
Credentials:APRN-CNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4405
Mailing Address - Country:US
Mailing Address - Phone:405-835-2771
Mailing Address - Fax:
Practice Address - Street 1:3617 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4405
Practice Address - Country:US
Practice Address - Phone:405-835-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily