Provider Demographics
NPI:1184947210
Name:RIDGWAY, SHELLEY ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4684 WENMAR DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2817
Mailing Address - Country:US
Mailing Address - Phone:989-793-6373
Mailing Address - Fax:989-793-7649
Practice Address - Street 1:4684 WENMAR DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2817
Practice Address - Country:US
Practice Address - Phone:989-793-6373
Practice Address - Fax:989-793-7649
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily