Provider Demographics
NPI:1851889943
Name:RIDDER, PAIGE HAZELTON (MS)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:HAZELTON
Last Name:RIDDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:ELIZABETH
Other - Last Name:HAZELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-6353
Mailing Address - Country:US
Mailing Address - Phone:507-538-5219
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-6353
Practice Address - Country:US
Practice Address - Phone:507-538-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1459170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS