Provider Demographics
NPI:1750452207
Name:RIDENOUR, DENA LEE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DENA
Middle Name:LEE
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SNEFFELS ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5424
Mailing Address - Country:US
Mailing Address - Phone:913-449-2900
Mailing Address - Fax:
Practice Address - Street 1:1540 SNEFFELS ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5424
Practice Address - Country:US
Practice Address - Phone:913-449-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO116612163WP0809X
CO0101420364SP0809X
CO2356364SP0809X, 364SP0809X
KS74417364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO475161YMWYOtherMEDICARE PTAN
KS100098080AMedicaid
MO307C00039OtherMEDICARE PTAN
CO83978356Medicaid
KS3629298OtherMEDICARE PROVIDER NUMBER