| NPI | 1699966150 |
|---|---|
| Former Name | JANE ELLEN RIDDLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MN L053985 6) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: ND L11842) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-08-08 |