Provider Demographics
NPI:1538515820
Name:RIDDICK, DONNA L (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SHADOWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5128
Mailing Address - Country:US
Mailing Address - Phone:757-288-0946
Mailing Address - Fax:757-673-0907
Practice Address - Street 1:325 SHADOWLAKE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5128
Practice Address - Country:US
Practice Address - Phone:757-288-0946
Practice Address - Fax:757-673-0907
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001227330163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse