Provider Demographics
NPI:1679570030
Name:RIDER, CHRISTINA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:RIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 HOSPITAL DR
Mailing Address - Street 2:P.O. BOX 430
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-6600
Mailing Address - Country:US
Mailing Address - Phone:515-832-7800
Mailing Address - Fax:515-832-9498
Practice Address - Street 1:2350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-6600
Practice Address - Country:US
Practice Address - Phone:515-832-7800
Practice Address - Fax:515-832-9498
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8409559Medicaid
WA8409559Medicaid
Q30898Medicare UPIN