Provider Demographics
NPI:1538281969
Name:RIDGWAY, TINA G (APRN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:G
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 FARNAM ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2868
Mailing Address - Country:US
Mailing Address - Phone:402-552-2900
Mailing Address - Fax:402-552-2901
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:SUITE 800
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-552-2900
Practice Address - Fax:402-552-2901
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110081163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory