Provider Demographics
NPI:1831537612
Name:RIDLEY, SHIRLEY (RN)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 CALEDONIA ST
Mailing Address - Street 2:2B
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-2932
Mailing Address - Country:US
Mailing Address - Phone:717-657-7626
Mailing Address - Fax:717-657-1918
Practice Address - Street 1:1913 CALEDONIA ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-2932
Practice Address - Country:US
Practice Address - Phone:717-657-7626
Practice Address - Fax:717-657-1918
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN618483163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management