Provider Demographics
NPI:1124770342
Name:RIDGILL, RACQUELL (RN)
Entity type:Individual
Prefix:
First Name:RACQUELL
Middle Name:
Last Name:RIDGILL
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 1:1854 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7541
Mailing Address - Country:US
Mailing Address - Phone:609-510-7216
Mailing Address - Fax:
Practice Address - Street 1:1854 LANTANA DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7541
Practice Address - Country:US
Practice Address - Phone:609-510-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000038986348343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)