Provider Demographics
NPI:1760580708
Name:RIDDELL, DEBORAH J (APN CNM)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:RIDDELL
Suffix:
Gender:F
Credentials:APN CNM
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Mailing Address - Street 1:2040 OGDEN AVENUE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:2972 INDIAN TRAIL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502
Practice Address - Country:US
Practice Address - Phone:630-897-7700
Practice Address - Fax:630-897-7701
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL309001170367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4521469OtherBC/BS