Provider Demographics
NPI:1134413115
Name:RIDGDILL, WESLEY EVAN (RN)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:EVAN
Last Name:RIDGDILL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-2103
Mailing Address - Country:US
Mailing Address - Phone:303-548-0319
Mailing Address - Fax:
Practice Address - Street 1:456 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-2103
Practice Address - Country:US
Practice Address - Phone:303-548-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-140945163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse