Provider Demographics
NPI:1790646263
Name:RYDBERG, PAUL MATTHEW (AEMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MATTHEW
Last Name:RYDBERG
Suffix:
Gender:M
Credentials:AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22109 N RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-8555
Mailing Address - Country:US
Mailing Address - Phone:702-556-3753
Mailing Address - Fax:
Practice Address - Street 1:22109 N RIVER DR
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8555
Practice Address - Country:US
Practice Address - Phone:702-556-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA2075747146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate