Provider Demographics
NPI:1508125469
Name:RIEDY, MELINDA D (RN, MSN, CNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:D
Last Name:RIEDY
Suffix:
Gender:F
Credentials:RN, MSN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2374
Mailing Address - Country:US
Mailing Address - Phone:419-668-1341
Mailing Address - Fax:
Practice Address - Street 1:24 HYDE ST
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889-9301
Practice Address - Country:US
Practice Address - Phone:440-839-2226
Practice Address - Fax:440-839-1339
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13336363LA2200X
OH13336-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064983Medicaid
OH0064983Medicaid
OH9389631Medicare PIN
OH3025372Medicaid