Provider Demographics
NPI:1447567557
Name:RIDLON, JOANNE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ELIZABETH
Last Name:RIDLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FARM VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-3856
Mailing Address - Country:US
Mailing Address - Phone:207-627-6014
Mailing Address - Fax:
Practice Address - Street 1:2 FARM VIEW RD
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-3856
Practice Address - Country:US
Practice Address - Phone:207-627-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECIT33174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist