1972971729 NPI number — PATRICIA FISKE RIDLEY, PH.D., LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972971729 NPI number — PATRICIA FISKE RIDLEY, PH.D., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA FISKE RIDLEY, PH.D., LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972971729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26697B PLEASANT PARK RD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
CONIFER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80433-7739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-818-1313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26697B PLEASANT PARK RD
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
CONIFER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80433-7739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-818-1313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RIDLEY
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
FISKE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
303-679-1429

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2667 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 867042 . This is a "BEACON" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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