Provider Demographics
NPI:1437490638
Name:RIDENOUR, RYAN G (CRNA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:G
Last Name:RIDENOUR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 REED RD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-457-2306
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED RD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-457-2306
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 338558163W00000X
FL9309052163W00000X
OHCOA 14410-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH338558OtherOHIO RN LICENSE
OH0083383Medicaid
OHP01179944OtherMEDICARE RAILROAD
OHH186210Medicare PIN