Provider Demographics
NPI:1528207263
Name:WALKER-RIDENOUR, NAYESHA
Entity Type:Individual
Prefix:MRS
First Name:NAYESHA
Middle Name:
Last Name:WALKER-RIDENOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAYESHA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:5239 ALGEAN DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8459
Mailing Address - Country:US
Mailing Address - Phone:614-920-0434
Mailing Address - Fax:614-920-0434
Practice Address - Street 1:5239 ALGEAN DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8459
Practice Address - Country:US
Practice Address - Phone:614-920-0434
Practice Address - Fax:614-920-0434
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 102402164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse