Provider Demographics
NPI:1801036629
Name:RIDLEY, ELIZABETH C (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4948 BENCHMARK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2027
Mailing Address - Country:US
Mailing Address - Phone:618-628-2588
Mailing Address - Fax:618-628-1363
Practice Address - Street 1:4948 BENCHMARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2027
Practice Address - Country:US
Practice Address - Phone:618-628-2588
Practice Address - Fax:618-628-1363
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2020-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085004498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant