Provider Demographics
NPI:1477511517
Name:RIDGLEY, JULIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:RIDGLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DEXTER CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-344-6600
Mailing Address - Fax:563-344-6699
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-344-6600
Practice Address - Fax:563-344-6699
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-086516367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34796OtherBLUE CROSS BLUE SHIELD
IAP00105711OtherRAILROAD MEDICARE
IA0415471Medicaid
IAI10055Medicare ID - Type Unspecified
IA34796OtherBLUE CROSS BLUE SHIELD