Provider Demographics
NPI:1699767459
Name:RIDEOUT, BARBARA (CRNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5843 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1205
Mailing Address - Country:US
Mailing Address - Phone:215-877-8257
Mailing Address - Fax:
Practice Address - Street 1:850 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1957
Practice Address - Country:US
Practice Address - Phone:215-769-1100
Practice Address - Fax:215-769-1117
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004431C363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health