Provider Demographics
NPI:1962710525
Name:RIDDLEBERGER, BROOKE B (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:B
Last Name:RIDDLEBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7966 W KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4304
Mailing Address - Country:US
Mailing Address - Phone:303-320-8618
Mailing Address - Fax:
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-320-8618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical