Provider Demographics
NPI:1861136699
Name:RIDENOUR, CAROLYN SUE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:RIDENOUR
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 1:24427 21ST BRIDGE RD SW
Mailing Address - Street 2:
Mailing Address - City:RAWLINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21557-2332
Mailing Address - Country:US
Mailing Address - Phone:304-788-5467
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:24427 21ST BRIDGE RD SW
Practice Address - Street 2:
Practice Address - City:RAWLINGS
Practice Address - State:MD
Practice Address - Zip Code:21557-2332
Practice Address - Country:US
Practice Address - Phone:043-788-5467
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant