Provider Demographics
NPI:1497461362
Name:RIDER, ANNA MARIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:RIDER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51126
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-6126
Mailing Address - Country:US
Mailing Address - Phone:559-999-2024
Mailing Address - Fax:
Practice Address - Street 1:243 EL DORADO ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2914
Practice Address - Country:US
Practice Address - Phone:831-233-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner