Provider Demographics
NPI:1336847409
Name:RIDGEL, ARTESIA TENNILLE
Entity Type:Individual
Prefix:
First Name:ARTESIA
Middle Name:TENNILLE
Last Name:RIDGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 RICHWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8931
Mailing Address - Country:US
Mailing Address - Phone:616-655-0776
Mailing Address - Fax:
Practice Address - Street 1:1223 RICHWOOD DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8931
Practice Address - Country:US
Practice Address - Phone:616-655-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing