Individual
NATHANAEL W RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA, PHD
Contact information
Practice address
5770 S 250 E, #290, MURRAY, UT 84107-8100
(801) 747-8700
(801) 747-8701
Mailing address
5770 S 250 E, #290, MURRAY, UT 84107-8100
(801) 747-8700
(801) 747-8701
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
68336662501
UT
363AM0700X
Medical Physician Assistant
Primary
6833666-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780459016
NPPES
UT
Enumeration date
01/13/2011
Last updated
11/24/2023
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