Provider Demographics
NPI:1417328626
Name:RIPLEY, RODNEY ALAN JR (STNA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:ALAN
Last Name:RIPLEY
Suffix:JR
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37026 HAZEL RUN RD
Mailing Address - Street 2:
Mailing Address - City:SALINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43945-9742
Mailing Address - Country:US
Mailing Address - Phone:724-624-3558
Mailing Address - Fax:
Practice Address - Street 1:37026 HAZEL RUN RD
Practice Address - Street 2:
Practice Address - City:SALINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43945-9742
Practice Address - Country:US
Practice Address - Phone:740-491-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401264330711376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide