Provider Demographics
NPI:1699273615
Name:RIDLEY, DANA PATRICIA (MSN, APRN, AGNP-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:PATRICIA
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 EMILY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2823
Mailing Address - Country:US
Mailing Address - Phone:215-681-1884
Mailing Address - Fax:
Practice Address - Street 1:2024 EMILY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2823
Practice Address - Country:US
Practice Address - Phone:215-681-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO18517363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology